To link to the entire object, paste this link in email, IM or documentTo embed the entire object, paste this HTML in websiteTo link to this page, paste this link in email, IM or documentTo embed this page, paste this HTML in website

288009.pdf
[23.97 MB]
Link will provide options to open or save document.

File Format:

Adobe Reader

UN C CH HEALTH SCIENCES LIBRARY
H00352060G
i'
^bt Libtarp
of t^t
^nitjersitp of H^ortb Carolina
CnliotoeD b? ^^e SDiaUctic
ano
PSilantSropic &ocietie0
rsi86W
v.5B-4»
McJ. I.b.
This hooh must not
be taken from the
Library building.
5^
LUNC-15M N.36
OP-13370
DIVISION OF DOCUMENTSt
WASHIfJGTON, D. C.
PuTDlislyedbH inL. N°KJI\QP^UMIK STATE. DPARDs^AE^LTA
1 Th)5 Bu]1elir\willbe 5er\t free to arwj citizen of Ihe 5tcrte upoi\ request j
Entered as second-class matter at postogice at Raleigh, N. C, under Act of July 16, 1894,
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. XLI JANUARY, 1926 No. 1
HEALTH—THE STATE'S GREATEST ASSET
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Wat, M.D., Pres Waynesville Cyrus Thompson, M.D Jacksonville
Richard H. Lewis, M.D., LL.D. Raleigh E. J. Tucker, D.D.S Roxboro
Thomas E. Anderson, M.D Statesville D. A. Stanton, M.D High Point
A. J. Crowell, M.D Charlotte James P. Stowe, Ph.G Charlotte
Charles O'H. Laughinghouse, M.D.,
Greenville
EXECUTIVE STAFF
G. M. Cooper, M.D., Assistant Secretary.
H. A. Taylor, M.D., Deputy State Health Officer.
C. A. Shore, M.D., Director State Laboratory of Hygiene.
H. E. Miller, C.E., Chief of Bureau of Engineering and Inspection
F. M. Reglster, M.D., Deputy State Registrar of Vital Statistics.
M. L. Townsend, M.D., Director Bureau of Health Education.
FREE HEALTH LITERATURE
The State Board of Health publishes monthly The Health Bulletin,
which will be sent free to any citizen requesting it. The Board also has
available for distribution without charge special literature on the following
subjects. Ask for any in which you may be interested.
Adenoids and Tonsils
Cancer
Catarrah
Care of the Baby
Constipation
Colds
Clean-up Placards
Chickenpox
Diiihtheria
Don't Spit Placards
E.\es
Flies
Fly Placards
German Measles
Hookworm Dif-ease
Infantile Paralysis
Indigestion
Influenza
Malaria
Measles
Pellagra
Public Health Laws
Prenatal Care
Sanitary Privies
Scarlet Fever
Smallpox
Teeth
Tuberculosis
Tuberculosis Placards
Typhoid Fever
Typhoid Placards
Venereal Diseases
Water Sup])lies
Whooping Cough
FOR EXPECTANT MOTHERS
The Bureau of Maternity and Infancy has prepared a series of monthly
letters of advice for expectant mothers. These letters have been approved
by the medical profession. They explain simply the care that should be
taken during pregnancy and confinement, and have proved most helpful
to a large number of \yomen. If you want them for yourself or a friend,
send name to the State Board of Health, and give approximate date of
expected confinement.
CONTENTS
Pneumonia 3
Biliousness 3
"I Never Thought of That" 5
Winning the Typhoid Fight 7
Condensed and Evapora ed Milk -Tr^ll
The Advancing Knowledge ol" Cancer-- 14 ^e¥ Hr^len
Public Health Nursing-
Look to Wholesome Home Environment 24
Children Spoiled by too Much Love 25
Importance of Being a Parent 26
No Ventilation—Six Lives Lost 26
"Care^mw-'Iloothbrush 27
27
;he Bath 30
RECEtVCO
19 The Story of
JAN 1 f) 1926
nor~l IftiiPibi-re r\*\, ttLit-\%A
I PU5LI5ALD BY TML nQR.TA CAgOLIhA 5TATE. BOAfgP g^MLALTM I
Vol. Xlil JANUARY, 1926 No. 1
PNEUMONIA
We are just now reaching the season
when pneumonia is beginning to talce
its most territic toll of human life.
During January, February and March
more people die from this disease than
during the remaining nine months of
the year. During these three months
of 192.5 pneumonia killed, in North
Carolina, at the rate of over five hun-dred
per month.
If you live in a village of five hun-dred
people, think of an entire village
tlie size of yours, men, women and chil-dren,
being completely wiped off the
map in this State each month during
January, February and March. Re-member
that is just what this one
dibcase, pneumonia, is doing. The total
is approximately 3,000 deaths per year.
Pneumonia can much more easily be
prevented than cured and prevention is
a personal matter depending on each
individual. The doctor will do all he
possibly can to relieve a patient that is
sick, but preventing the disease is a
matter entirely in the hands of the in-dividual.
The doctor cannot do that
for him any more than he could eat
his food for him or sleep for him.
In one series of 1408 pneumonia pa-tients,
taking them as they came 852
gave a history of having been ill with
a common cold for several days previ-ous
to the development of pneumonia.
Some important measures in prevent-ing
pneumonia which every one should
know are
:
1. Consider seriously and treat ade-quately
all "common colds."
2. Dress to suit the weather, remem-bering
that clothing is for protection,
rather than alone for adornment.
3. Avoid sudden chilling, wet feet and
wet clothing.
4. Vitality, or resistance to infection,
is greatly lowered by lack of exercise,
excessive fatigue, loss of sleep, excesses
of any kind, and poor food.
During dangerous seasons be especial-ly
careful to maintain vitality at its
very highest.
5. Avoid all unnecessary contact with
persons sick with pneumonia, flu or
colds. They are contagious.
6. Keep hands clean.
7. Do not let fingers or anything else
except proper food and drink enter the
mouth or touch the lips.
8. Avoid overheating of living rooms
and be assured that there is ample
ventilation to keep the air fresh.
BILIOUSNESS
The term "biliousness" may not be a
strictly scientific word but hearing it
calls to the mind of every man, woman
and older child in North Carolina a
certain definite and unhappy picture.
By whatever name it may be called
there is lack of appetite, a sense of
malaise, indisposition to either mental
or physical activity, drowsiness, often
giddiness, a bad taste in the mouth
and a bad breath, the tongue is cov-ered
with a rather thick slimy coating,
there is inactivity of the bowels and a
peculiar "bilious" color in the skin,
dark circles under the eyes and usually
there is a severe and distressing head-ache.
Sooner or later there will be
nausea and vomiting. The vomited
matter is a liquid, yellow, or greenish
yellow in color and as "bitter as gall."
This condition has been seen by every
one and experienced by most persons.
The Health Bulletin January, 1920
A condition of this sort confronts the
"family doctor" more often, perhaps,
than all others combined.
Gallstones forming in the gall blad-der
sometimes stop up the gall ducts
and prevent the flow of bile into the in-testines.
This dammed up bile is then
reabsorbed into the blood and carried
throughout the system and deposited
in every tissue of the body. .This de-posited
bile pigment is what gives to
the skin and the whites of the eyes
that "yellow as a pumpkin" jaundiced
color.
In at least a great many cases of so-called
"biliousness" there is a slightly
analagous condition caused by a con-centration
of the bile. This interferes
with its normal flow and results in its
reabsorption into the blood, to be partly
deposited in the tissues and partly to
be re-eliminated by the liver. With each
cycle, of course, it becomes more and
more concentrated. In biliousness the
bile is not dammed up as in gall-stones
but because of the impeded
flow of the thickened bile there is re-absorption
into the blood and a deposit
of bile pigment into the tissues.
Because of the inactivity of the
bowels in this condition there is neces-sarily
a reabsorption also of the poisons
from uneliminated waste in the intes-tines
and this poison or toxin together
with the reabsorbed bile gives rise to
many of the symptoms noticed.
Inseparably linked with the word
biliousness is that other word, calomel.
Calomel has a double action. It is a
purgative and also a cholagogue (bile
driver), hence calomel in "biliousness"
empties the intestinal tract and also
liquefies the bile and stimulates the
liver cells to excrete more bile. Thus
with the intestines emptied the bile
ducts and gall bladder emptied and the
liver cells filtering out of the blood the
accumulated bile the condition speedily
clears up.
Calomel, however, has its disadvant-ages.
It is of itself a very poor pur-gative
and should never be taken, ex-cept
upon the specific advice of a phy-sician.
When taken into the stomach
and absorbed into the blood it is an
excellent stimulant to liver activity. Its
absorption is rather slow, hence should
be taken in the minimum needed doses
to accomplish this purpose and given
time to be absorbed before a purgative
is taken to empty the bowels.
Epsom salts and castor oil are ex-cellent
purgatives. They do quickly
and thoroughly empty the intestinal
tract but they have no stimulating ac-tion
on the liver and do not liquefy the
bile. These drugs by themselves will
not clear up the symptoms of the con-dition
popularly known as biliousness.
If, however, the bowel contents are
never allowed to stagnate, then bilious-ness
is much less likely to occur, and
such drugs are much more valuable in
preventing biliousness than in curing
it. In recent years a mechanical method
has been devised of draining the gall
bladder without the use of purgation.
It consists in the passage of a small
tube by swallowing it very like a
stomach tube through the stomach and
into the duodenum (the upper small in-testine).
The procedure is simple and
usually gives the patient little incon-venience
but does require some time. In
cases where indicated it often gives
most happy results.
"Biliousness" may not be the proper
name for it but the condition described
is very real and very common. It is
relieved by anything that empties the
bowels to stop further toxemia and by
emptying the gall bladder and clearing
from the body tissues the accumulated
bile and waste iwisons.
The health oflicer who operates in a
community where a substantial propor-tion
of the citizens have received basic
instruction in preventing disease and
in the general activities of the health
department is able to accomplish re-sults
in the saving of lives of which
we have scarcely dreamed in the phil-osophy
of the past.
—
Dr. Ray Lyman
Wilbur.
Education is the basis on which any
dental health program should be de-veloped.
It should begin in the pre-natal
clinics and should extend through
the school life of the child. Filling a
cavity is palliative treatment unless !
one understands and practices the
|
fundamentals of preventive dentistry. | —William A. Griffin, D. D. S.
January, 1926 The Health Bulletin
''I NEVER THOUGHT OF THAT"
One Reason Why Over Ten Thousand People Die Each Year in the
State From Deg-enerative Diseases is Just Plain Carelessness
"Hello, Sam, what's wrong with you?
Been in a wreck?"
That was the greeting of a fi-iend as
Sam Jones limped painfully along to-wards
his office on a snappy December
morning.
"No, nothing like that, Bob," Sam
replied. "Fact is, it's nothing but a
touch of rheumatism. Sure is talking
to me this morning, though. Been
troubling me a little in that left knee
for some little time. Now it's moved
on up into the hip, and it's just about
all I can do to travel this morning."
"What are you walking for? Where's
the car?" Bob wanted to know.
"It's over at the shop. I'm having it
wne over thoroughly, like I do every
three months. Say, Bob, that's the best
investment I ever made. You know,
I've had that car something over three
years now, drive it pretty constantly,
and repairs on it haven't amounted to
hardly anything. Every three months
I set it in the shop for an inspection,
and they fix up what little minor
trouble there may be, and it runs just
as sweet now as it did when I got it.
It's mighty good practice, and cheap
insurance, I tell you."
"How long since you have had a doc-tor
look you over?" Bob inquired.
"Let's see now, I don't believe I've
had a doctor since I had the flu back
in 1918. There's been nothing wrong
with me except this rheumatism here
lately."
"Well, then, do you think more of
your car than you do of yourself?" Bob
wanted to know. "Or do you think at
all? Here you have your car carefully
looked over every three months to keep
it from going bad, and you let your-self
go for seven years. Why don't you
apply the same reasoning to yourself
as you do to your car? If you had you
probably wouldn't be so crippled up
with rheumatism that you can hardly
walk down town. Besides, that rheuma-tism
is only a symptom of something
wrong inside. Better go right on over
and have a careful examination made."
"Bob, I reckon I'm just a plain fool,
I never thought of that. I'm on my
way right now."
There are thousands in North Caro-lina
just like Sam Jones. They go on
day after day, and the days run into
weeks, and months, and years, and they
never think of giving their bodies a
square deal. Their automobiles cost
money, and so they spend money keep-ing
them in good order, and spend
money in preventing trouble from de-veloping.
But only when sick, and too
sick to work, do they seek relief. Then
they want a quick job from the doctor,
one that will put them back on their
feet in a hurry, regardless of what may
be the hidden trouble.
At the beginning of another year, it
is timely to suggest that a physical ac-counting
be made. What are your
health assets and liabilities, and how
do your body accounts balance? You
would not think of running your busi-ness
without keeping some accounts,
and the annual inventory is routine.
Why run your body without getting at
least a yearly balance to show if there
are any losses or gains?
It is a well-known fact that thou-sands
of lives in infancy and childhood
Lave been saved in the past few years
by the spread of knowledge concerning
the care of babies and child hygiene,
and the medical inspection of school
children. Not only have thousands of
lives been saved, but these school chil-dren
have been made healthier and
more efficient in their school work.
But while the death rate among chil-dren
has been coming down rapidly, the
death rate for adults has been climb-ing.
We are saving infant life and
wasting adult life. The "old age"
diseases are creeping into middle life
and carrying off men and women at the
time when their lives are most useful,
and when they should be enjoying life
6 The Health Bulletin January, 1926
to the fullest. At least a half million
American citizens die annually from
preventable or postponable diseases of
the heart, arteries, kidneys and cancer.
Here in North Carolina last year
there occurred 11,964 deaths from a
group of five preventable or curable
diseases to vrhich persons of middle life
It is estimated that 75 of each 100
deaths between the ages of 20 and 65
are caused by one of these diseases.
The majority of the more than eleven
thousand occurring from these causes
were premature. They should have been
prevented, cured, or postponed to be-yond
seventy years of age.
THOROUGH CHEST EXAMINATION
Important part of physical examination to detect incipient tuberculosis.
are especially susceptible. The figures Wonderful progress has been made
are as follows
:
in North Carolina in improving the
Nephritis 1,804 health of children; in the control of
Heart Disease 3,661 the communicable diseases; in better-
Apoplexy and arterio-scle- ing sanitary conditions throughout the
rosis 2,509 State. There is much yet to be done.
Cancer 1,289 however, and an imrwrtant next step
Tuberculosis 2,701 must be towards the raising of the phy-
• sical standard. By learning the lesson
Total 11,964 of prevention we can get at these de-
January, 1926 The Health Bulletin
generative diseases in time to stop or
cure them. Through a periodic physical
examination, at least once a year, bodily
defects and the early signs of the
"breaking down" diseases of the heart,
arteries and kidneys can be detected
and the necessary remedy applied.
The cost is negligible. Thirty minutes
to an hour of your time, and a modest
fee to the physician is all. The gain
to you may be ten or twenty years of
added life. It may be that you have
no symptoms so far as you know, and
don't feel sick, and yet a thorough
physical inspection may reveal the first
indications of a serious disease at the
time when it may be headed off or
cured. The 1,289 who died of cancer
last year did not know they were sick
until it was too late. Yet every one
of them could have been saved had
their trouble been discovered in time.
Give j-ourself a square deal. Treat
your body with as much care as you
give to your car. Start the New Year
with a physical inventory.
/ WINNING THE TYPHOID FIGHT
How North Carolina Has Succeeded in Makings Typhoid Fever
Comparatively Unknown in the State
In the past eleven years the death
rate from typhoid fever in North Caro-lina
has been reduced by 72 per cent.
From its position near the top in the
United States the State has been pulled
down to a place among those states
having the least typhoid fever, and now
heads the list of the Southern States
with the lowest death rate fi-om this
particular disease.
To those whose memory goes back to
the early days of the present century
when typhoid fever was accepted as a
natural accompaniment of the summer
months, the question naturally arises,
how has this disease been so nearly
conquered? A prominent newspaper
editor of the State last summer re-marked
that he could remember when
every week his paper carried the report
of five or six or more deaths from ty-phoid,
and now even a case in the
county was unusual.
The intensive fight against typhoid
fever began in 1914, when definite plans
were adopted to be carried into effect
the following year. Vaccine for the
prevention of typhoid fever had been
thoroughly tested and its efficacy estab-lished.
So the State Board of Health
decided to attempt mass immunization
on a large scale.
Under the guidance of Doctor G. M.
Cooper, then serving as director of
rural sanitation for the Board, con-tracts
were made with seventeen coun-ties
under the terms of which the coun-ty
authorities appropriated sums suf-ficient
to pay the expenses of the field
agents of the Board. Dispensary points
in each county were selected that would
be as convenient as possible for the
people of each section to reach. An ad-vertising
campaign designed to give full
information with regard to the preva-lence
of the disease, its dangers, and
the means of prevention was inaugu-rated.
In June the actual work was
begun.
In these counties a total of 52,000
complete inoculations were given that
summer. That is, that many persons
received three administrations of ty-phoid
fever vaccine, the doses being
given at intervals of one week. The
response on the part of the people was
enthusiastic. The results were much
greater than had been anticipated, and
this first year's campaign was consid-ered
an unqualified success.
For the first time in th-^ United States
the effort had been made to reach a
large mass of civilian population with
preventive typhoid treatment. It was
demonstrated that such a campaign
could be successfully consummated.
Due credit should be accorded the coun-ty
authorities who made this preventive
work possible, and to the citizens of
those counties who so whole-heartedly
responded. The seventeen counties were
Alamance, Buncombe, Cabarrus, Cald-well,
Craven, Cumberland, Durham,
Edgecombe, Guilford, Henderson, New
The Health Bulletin January, 1926
TABLE 1
Check mark indicates counties in wliich typhoid vaccination campaigns
were conducted by State Board of Health, or local county health department,
1915-1925.
Total complete vaccinations, 807,978.
County
January, 1926 The Health Bulletin
TABLE 2
Twelve counties in which no typhoid vaccination campaigns was con-ducted,
1915-1925, showing death rate from typhoid fever by years for
seven years, 1918-1924, inclusive.
Cot7NTr 1£18
10 The Health Bulletin January, 1926
vear, the record complete being as fol-lows
: 1915, 17; 1916, 15; 1917. 10;
1918, 14; 1919, 35; 1920, 32; 1921, 57;
1922, 53; 1923, 44; 1924, 48; 1925, 52.
The frequency with which immuniza-tion
campaigns have been conducted in
individual counties is shown in the ac-companying
table. It will be noted that
in twelve of the counties there have
been no campaigns throughout the pe-riod,
while in some others there has
been one each year continuously since
the beginning of the work. Altogether
for the eleven year period the State
Board of Health has records showing
807,978 complete vaccinations. This in-cludes,
of course, those persons who
have followed the safe course and been
re-vaccinated at intervals of three
years. It does not include a large num-ber
of inoculations given by physicians
in the routine course of their practice.
the number of which it is not possible
to accurately estimate.
Now all this was costly. It cost in
time and energy and money. Did it
justify itself in direct, tangible results?
The answer is shown by the figures that
follow.
In 1914 the total deaths from typhoid
in the State numbered 839, giving a
death rate of 35.8 per 100,000 of popu-lation.
In 1924 the deaths from typhoid
in the State numbered 270, giving a
death rate of 9.9 per 100,000 of popu-lation.
The reduction in the death rate
was 72 per cent. Or to put it another
way, if no efforts had been made to
eradicate typhoid fever, and the same
death rate had prevailed in 1924 as in
1914, 967 citizens would have succumbed
to the disease. For the year, as com-pared
with eleven years previously,
there was a saving of 697 lives, and ten
times the saving in serious illness. The
accumulated saving of lives year by
year for the eleven years would total
the population of a small- city.
It has been noted that twelve coun-ties
in the State have had no intensive
anti-typhoid work. They are Ashe,
Cherokee, Dare, Graham, Haywood,
Jones, Macon, Madison, Pender, Polk,
Transylvania and Tyrrell. These are
nearly all located either in the moun-tains
or on the coast, are small, and
sparsely populated. The total popula-tion
for the twelve Is only 155,521. No
one of them contains any considerable
groups of urban population. In such
counties typhoid fever and other com-municable
diseases would be expected
only as sporadic cases, the opiwrtuni-ties
for spread being extremely re-stricted.
Against this group of twelve counties
which have made no effort to eradicate
typhoid fever may be compared a group
of twelve others in which anti-typhoid
efforts have been most continuous and
intensive. These counties are Cabarrus,
Cumberland, Durham, Guilford. New
Hanover, Northampton, Pitt, Robeson.
Rowan, Sampson, Wake and Wilson.
Almost without exception the.se coun-ties
are large and thickly populated.
They contain many large groups of
urban population, and present excellent
opportunities for the quick spread of
typhoid fever and other communicable
diseases. The total population of these
twelve is 589,358.
Detailed statistics year by year for
1918-1924 inclusive are given for the
two groups in an accompanying table.
For convenience the first twelve, or
those having had no anti-typhoid work,
are called Group A. and the second
twelve, or those having had the most
intensive anti-typhoid work. Group B.
The following is a comparative show-ing
of the typhoid death rates in the
two groups, the avei'ages for the seven
years.
1918 1924 Reduction
Group A .... 13.8 9.9 28%
Group B .... 26.5 8.8 67%
State 22.2 9.9 55%
While the death rate dropped in the
Group A counties from 13.8 to 9.9, a
difference of 3.9, in the Group B coun-ties
it dropped from 26.5 to 8.8., a dif-ference
of 17.7. The comparison of the
rates of reduction shows 39% greater
reduction for the group of counties
doing intensive work, and this in spite
of their natural handicaps. From the
showing made, it can be said that had
the Group A counties made the same
etScient efforts to eliminate typhoid as
were made by Group B counties, then
those counties now would be practically
free from the disease.
Expressing it in terms of total deaths
rather than rates, in 1918 Group A
counties had 29 deaths from typhoid
and in 1924 they had 22, a difference
January, 1926 The Health Bulletin 11
of only seven. Group B counties in
1918 had 128 deaths from typhoid and
in 1924 had 56, a difference of 72. Had
the same intensive anti-typhoid meas-ures
been applied in Group A counties
as were utilized by Group B counties,
the results should have been certainly
as successful, and probably more so be-cause
of natural advantages in these
counties. The same degree of reduction
in typhoid would have meant a saving
of 20 lives in these counties for 1924
as compared with 1918, instead of
seven, and the sickness and loss sus-tained
by having had about 150 pre-ventable
cases of the disease. Consider-ing
the nominal cost of securing ty-phoid
vaccinations, it would appear
that these counties practiced a false
economy.
Of course, other factors have con-tributed
to the decline, in addition to
the vaccinations that have been secured.
Foremost among these other factors
is the immensely improved sanitary
conditions that have resulted from the
enforcement of the sanitary privy law,
enacted in 1919. The number of pro-tected
public water supplies, and sew-erage
systems, has been growing, and
the total number of people so served
more than doubled in the past ten years.
Dependable milk control measures
have been instituted by a number of
communities. The general educational
work of the Board has been amplified
in character and has been constantly
reaching an increasing number of peo-ple
each year. But these additional
factors affecting the typhoid death rate
have been general, on a State-wide
basis, so that the effect has been fairly
evenly distributed over all counties. It
would appear conclusive, therefore, that
the determining factor in the reduction
of the typhoid death rate in those coun-ties
where it has been greatest has
been the fact that a large portion of
the population of those counties have
been periodically vaccinated.
Let us consider for a moment what
a skillful owner of horses does for
a very fine colt, the progeny of ex-traordinary
parents—one that is worth
100 times as much as the average
horse. His first consideration is to
provide for it the right kind of food;
food which experience has shown will
be ample for the support of optimal
growth and for the maintenance of
health after growth is completed. Be-yond
this he does little in any special
way to look after its well-being other
than to provide clean, wholesome sur-roundings
and to give it an opportunity
to take exercise as it desires. It is
not put through a lot of contortions
or made to lie on its back and kick
its legs to get exercise of a suitable
nature; it walks, trots or runs, it
grows into a magnificent creature. It
rests a great deal of the time.—E. V.
McCOLLUM.
The most important of the laws of
health relates to the character and
quality of our food. Second in impor-tance
is the effectiveness with which
we rest. I would put exercise third.
—
E. V. McCOLLTTM.
CONDENSED AND EVAPORATED MILK
Frank E. Rice, A.B., Ph.D., Professor of Biological and Agricultural Chemis-try,
N. C. State College, Raleigh, N. C.
There is much confusion in most peo-ple's
minds regarding the various kinds
of canned milk found on the market.
Really there are two, and only two,
kinds of concentrated liquid milk put
up in tin cans, although there are sev-eral
manufacturers' brands. Both con-tain
considerably less water than is
found in ordinary fresh cow's milk;
both are, therefore, condensed milks.
Both are made by evaporating part of
the water from cow's milk; both are,
consequently, evaporated milks. The
main difference between them is that
the one contains a large amount of
added sugar, while the other does not.
Sweetened condensed milk, or what
is commonly called condensed milk, is
very thick or viscous, and is yellowish
ir. color; it contains 40 to 457o ordi-
12 The Health Bulletin January, 192G
nary granulated sugar. Unsweetened
condensed milk, which is ordinarily
designated as evaporated milk, is about
the consistency of light cream, and is
darker in color than condensed milk
;
it contains no added substance.
Condensed milk is kept from spoiling
by the sugar in it, just as fruit pre-serves
and molasses i-emain good almost
indefinitely. Evaiwrated milk, on the
other hand, after being sealed into the
can perfectly tight, is heated to a very
high temperature to kill the bacteria.
This process can be compared to the
ordinary method of canning fruit. It
is well known that when canned fruit
is once opened and exposed to the air
it will spoil unless kept on ice ; the
same is true of evaporated milk. But
the sweetened variety after opening
keeps just as well as before; there is
no more necessity for keeping it cold
than for keeping honey and molasses
cold in order to prevent spoilage. Of
course, if left undisturbed for weeks a
little mold may grow on the surface,
but the main body of the milk is un-harmed
and unchanged.
During the process of manufacture
of both condensed and evaporated milk,
the raw cow's milk is subjected to high
temperatures. There has always been
a diversity of opinion as to whether
heated milk is as nutritious as that
which has not been heated. The argu-ments
seem to center around these
questions: (1) Are the vitamins de-stroyed?
(2) Is the milk rendered less
digestible? (3) Are there not some
peculiar living substances in milk which
are beneficial to our health, but which
are killed on exposure to heat? With
regard to these points there should
be found some difference between
evaporated and condensed milk because
the former is heated much longer and
to a higher temperature than the latter.
Of the principal vitamins so far dis-covered,
the scurvy-preventing vitamin
is usually present in milk in relatively
small amounts and it is most easily
destroyed by heat. Evaporated milk
can be expected to contain none of the
anti-scurvy substance ; while one or two
investigators have found a little of this
vitamin in sweetened condensed milk,
it cannot be considered an important
factor.
Although a great deal depends upon
the care taken by the manufacturer in
preparing his i)roduct, both kinds of
canned milk can be expected to contain
practically as much of the other vita-mins
as raw milk.
With regard to digestibility,-—a few
investigators claim that raw milk is
better, but the large majority vote in
favor of milk that has been heated.
Raw cow's milk forms a tough clot in
the stomach, while heated milk becomes
finely divided and on this account is
more easily handled by that organ. The
protein of heated milk has been found
to be acted on more easily by the diges
five enzymes. Besides this, in the pro-cess
of manufacturing condensed and
evaporated milk the fat is rendered
very finely divided which makes it more
digestible also. All this is more im-portant
in considering the feeding of
infants and invalids than healthy
adults. To the latter, raw milk is just
as digestible as cooked milk. The im-portant
point just now is that there
is nothing peculiar about the process
of manufacturing canned milk that
renders it any less easily handled by
the digestive system than it was origi-nally.
However, there is one point of warn-ing
in this connection.—Any white sedi-ment
which is found in the bottom of
a can should be carefully stirred in
with the rest of the milk. It has been
found that the process of heating may
render some of the important mineral
salts insoluble and cause them to settle
out. Merely mixing this material with
the rest of the contents prevents any
loss.
Many people have thought that there
are some mysterious living substances
in cow's milk beneficial to digestion and
the health of man. They have thought
that by heating the milk these things
are destroyed and we are thus deprived
of their good effect. But this has
proved to be only supposition ; cow's
milk does not contain more than the
slightest trace of any digestive enzyme,
nor is there any specific substance that
can be destroyed with heat, such as an
immune body, which might assist the
bodies of children or grown-ups to re-sist
disease.
In answering the three questions
above propounded, condensed and evap-orated
milks are found to compare
January, 1926 The Health Bulletin 13
quite favorably with natural cow's milk
iu nutritive value.
The one big objection to the canned
milks, of course, is the taste. A glass
of milk made by mixing evaporated
milk and water, half and half, may
be just as nutritious as raw milk in
most resjiects, but it doesn't suit the
palate. The "cooked milk" taste may
come out sometimes in puddings and
soups. But it is not difficult to get into
the habit of using milk pi'oducts from
tins. Immediately after the Spanish-
American War the condensed milk busi-ness
grew more than at any previous
time. The soldiers had gotten used to
it, and introduced it to their families
when they got home.
There are a great many ways that
condensed and evaporated milk can be
used in food preparation wherein the
taste does not usually prove objection-able
: custards, puddings, sauces, cream
soups, ice cream, cakes, for adding to
coffee and cereals and for making
cocoa. Many people like sweetened con-densed
milk on pancakes instead of
sirup.
The next question is,—How does the
cost of canned milk compare with bot-tled
milk?
At the "Cash and Carry" stores in
Raleigh one pound tins of unsweetened
evaiwrated milk cost 11 cents and 12
cents depending on the brand ; suppose
we take ll\'-2 cents as the average. By
mixing this with an equal amount of
water two pounds of milk of average
composition is obtained. This is about
93% of a quart, which makes a quart
cost us about 12% cents. Therefore,
if we are paying more than this for
bottled milk we would be saving money
by using evaporated canned milk as
much as possible.
At the charge and delivery stores ihe
same can costs 14 or 15 cents. By using
an average of 14i/^ cents and calculat-ing
iu the same way we find that it
would cost about 15 1/^ cents to make a
quart.
Buying evaporated milk in the small
six-ounce tins is considerably more ex-pensive
as would be expected.
Sweetened condensed milk comes
mostly in 14-ounce tins ; one well known
brand is put up in 15-ounce tins and
another in 11-ounce. The label may be
expected to show the exact net contents
of the can since the laws are very
strict in this regard. The 14-ounce size
was found to cost 16 cents, the 15-ounce
20 cents, and the 11-ounce 14 cents at
most of the stores.
An inspection of these figures shows
that the 14-ounce size is by far the
most economical. It is unnecessary and
unwise to pay fancy prices for any
particular brand of canned milk just
because it is a little more widely adver-tised.
The pure food laws and sanitary
regulations nowadays are so strict that
one can depend upon it that one manu-facturer's
brand will be as good as an-other.
Sweetened condensed milk contains
289o milk solids ; ordinary cow's milk
about 12.75%. With these figures it
can be calculated that to make a quart
(2.15 pounds) of milk it will require
1% 14-ounce cans, or 18 cents worth.
However, since the product contains
about 43% sugar, worth 6V^ cents a
pound, there is present 2% cents worth
of sugar. This deducted from 18 cents
leaves 151/^ cents as the cost of making
the quart.
To sum up then,—unsweetened evap-orated
milk at 11 or 12 cents per pound
can is equivalent to natural cow's milk
at 12% cents a quart. The value of
the milk in a 14-ounce can of sweetened
condensed milk is equal to natural milk
at 15V4 cents per quart. Most bottled
milk costs well above these figures in
Raleigh, and this is perhaps true of
the whole State of North Carolina. It
is evident, therefore, that it is economi-cal
to use these canned milks in the
place of bottled milk in most cases.
As far as cash value is concerned
these are the facts. But there are some
distinct advantages of canned milk over
bottled whole milk :—It can be de-pended
on to be free from dangerous
bacteria. No matter if the cows have
tuberculosis or the milkers have scarlet
fever, the germs of these diseases can-not
survive the manufacturing process ;
so the finished product will be free
from them. There is likely to be less
waste in the use of cauntnl milk ; that
which is not used today can be used
tomorrow. Ice is not necessary before
the tin is opened, nor for the sweet-ened
variety after opening ; but un-sweetened
evaporated milk should not
14 The Health Bulletin January, 1926
be kept more than a day after opening
unless ice is used.
Of course, the big advantage that has
always been recognized is the porta-bility
of milk in tins. For camping
trips and for children on trains it is
readily carried and most useful. It
was once true that only on such special
occasions was it practicable to use milk
in tins. Now, with the price of tinned
milk low and bottled milk high, it is
economical to use these products every
day in the household, especially un-sweetened
evaporated milk.
Inasmuch as the nutritive value of
the canned milks is equal to fresh milk
in most respects, we may well urge
its use in those districts where fresh
milk cannot be obtained. It should be
possible to prevent pellagra by rounding
out the diet with canned milk as well
as with fresh milk. Of course, for this
as well as for all other maladies due to
improper nutrition fresh milk is best,
but if it is not available, by all means,
let canned milk form a part of the
diet. It is good, and the price is reason
able.
THE ADVANCING KNOWLEDGE OF CANCER
By George A. Soper, Ph.D., Managing Director The American Society for the
Control of Cancer
Some months ago the humorous re-mark
of a prominent physician to the
effect that nobody knew anything about
cancer, taken literally by a reporter
and published in evei-y newspaper in
the country, led the public to obtain an
utterly wrong idea of the state of
knowledge of this disease.
The doctor's remark produced a
hearty laugh among the many physi-cians
who heard it, for there was not
one who was not aware that the speak-er's
knowledge of the subject was ex-tensive
and detailed, nor failed to sym-pathize
with him in his exasperation
at the fact that the discovery of a
specific cure for cancer continued to
elude investigation.
It is as absurd to say that nobody
knows anything about life itself as to
say that nothing is known about can-cer.
A great many things are known
about life and about cancer, but of
course a great many things have es-caped
patient study in each case. How
much we think we know about any-thing
depends a good deal upon our
point of view. As the Chinese say, our
knowledge is like a fan which, held
close before our eyes, appears to com-prise
the universe, but to the eyes of
others usually forms but a very small
part of it.
The Existing Knowledge of Cancer
The information which exists today
in regard to cancer is not only more
extensive but of more practical value
than many persons suppose. It is suffi-cient,
if put into effect, to reduce the
present death toll by one-half among
women and one-third among men. At
least this is the opinion of Dr. Charles
P. Childe, President in 1923 of the
British Medical Association, a dis-tinguished
student of the cancer prob-lem.
If we apply this estimate to the num-ber
of deaths from cancer which occur
among men and women in the United
States, we shall find that over 40,000
people perish needlessly from this dis-ease
each year in this country. In other
words, according to Di*. Childe's opin-ion,
the lives of over 40,000 men and
women, most of them fathers and moth-ers,
many of them in the prime of
life and at the period of their greatest
usefulness, are annually sacrificed to
the failure to turn the knowledge which
exists concerning the prevention and
cure of cancer to account.
In many quarters fundamental facts
are being collected which are adding
to the sum total of information which
scientists and practicing physicians
possess as to the cause and cure of
the disease, and progress is being made
in another direction : the facts already
in existence are becoming better under-stood.
What is referred to here as the
knowledge of cancer is the composite
knowledge of those who are recognized '
Januury, 1926 The Health Bulletin 15
by the medical profession as qualified
students of that disease. As Dr. Joseph
Colt Bloodgood has said in a recent
letter to the l^ew York Times, the in-formation
on the cancer question which
is of real value is not the opinion of
one person however eminent or intelli-gent
he may be, but the consensus of
opinion of the world's authorities based
on the recorded experience of clinical
work and experimental research.
The reviewer of a book, in which the
claim was advanced that a specific had
been found that is a preventive and a
cure for cancer, said, "Cancer is such
a serious matter for the world at large
that the premature claim of having ar-rived
at a solution of this problem
and the unwarranted hope held out to
cancer sufferers by such an optimistic
statement is a matter for grave con-sideration."
Persons who would like to examine
for themselves into the amount and
character of the existing knowledge of
cancer cannot do better than to begin
with the work of Dr. Jacob Wolff, fol-low
this up with the latest edition of
"Neoplastic Diseases" by Dr. James
Ewing, Professor of Pathology at the
Cornell Medical School, and the refer-ences
to be found in the Index Medicus,
and so to the article in the latest An-nual
of the Encyclopedia Americana by
Dr. Francis Carter Wood, Director of
the Institute of Cancer Research of
Columbia University. Dr. Wolff's work,
called "Die Lehre von der Krebskrank-heit,"
is in three volumes and contains
2,626 pages; Dr. Ewing's book is 1,054
pages in length.
How the Knowledge is Increasing
It has been said that more progress
has been made toward an understand-ing
of cancer during the past fifty years
than during the preceding five hundred
years, from which it is fair to infer
that the advance which has been ac-complished
within the last fifty years
has been revolutionary.
The progress has been in more direc-tions
than can be stated within the
limits of this article. In the direction
of causation may be mentioned the dis-covery
that chronic irritation is almost
invariably one of the leading factors in
the production of cancer. As to cure,
the use of X-rays and radium has
furnished methods of treatment of in-calculable
service. Surgical procedures
have been developed to a point which
is believed to leave little more to be ac-complished
in this direction. With
reference to prevention, the whole idea
of preventing cancer by means of hy-gienic
procedures and minor surgical
and radiological treatments is not only
new but of so much value as to lead
many to think that cancer is more often
preventable than curable.
One of the results of the new knowl-edge
is that cancer can now be more
accurately diagnosed than formerly and
inestimable advantages are following
in consequence. One of these advan-tages
lies in the fact that there is today
little reason for physicians to postpone
a decision in those early cases which
come to them until a cure is no longer
possible.
Diagnoses are still difficult and not in-frequently
impossible in many early
cases, but in some of the most usual and
most curable forms and locations in
which cancer occurs they can generally
be made with certainty while there is
still time for the patient to be cured.
Cancer of the skin, for example, can
and should be diagnosed and cured in
practically every case, providing the
patient does his or her part. And so with
cancer of the lip, cancer of the breast
and cancer of the uterus. Cancer of the
buccal cavity is more readily diagnosed
than cured, although there are many
persons alive today who can testify that
cancer in this location is not hopeless,
by any means. In fact, cancer has been
successfully treated in practically every
location.
Value of Radium, X-rays and Surgery
As time passes, a better understand-ing
is being reached as to the relative
efticacj^ of radium, X-rays and surgery
and the several fields of usefulness of
these methods of treatment are being
more and more clearly defined.
The details of skillful operations are
being recorded with increasing accu-racy
and completeness, and the records
are being tabulated in larger numbers
and studied with increasing care. Mind-ful
of the fact that cancer may recur
after long intervals of time, the health
of persons who have been treated is
being watched for manv vears to see
16 The Health Bulletin January, 1926
how permanent their cures have been.
It has been possible to collect statistics
covering hundreds of cases and com-pare
the effects produced by radium
and X-rays with those obtained by
sui'gery in the treatment of cancer in
the various parts of the body where it
occurs. Thus for example there was
published in 1924 the report of a com-mittee
headed by Dr. Robert B. Green-ough,
which had been appointed by the
American College of Surgeons, in which
nearly one thousand cases of cancer of
the cervix of the uterus were brought
together witli the object of determining
the relative value of surgery, X-rays
and radium for the cure of cancer in
this particular location. In England,
the Ministry of Health has published an
analysis of 20,000 cases of cancer of the
breast, the object being to determine
by the record the efficacy of the various
methods of treatment employed.
So far as irradiation is concerned,
the net result of all the information
thus far collected is to show that, like
surgery, radium and X-rays have a dis-tinct
place in the treatment of cancer,
not only for the cure of that disease
but for the amelioration of the suffer-ing
in incurable cases. Not infrequently
surgical operations are advantageously
preceded and succeeded, one or both, by
this treatment.
Institutions Devoted to Cancel*
Research
The scientific knowledge which lies at
the basis of a true conception of the
causation, prevention and cure of can-cer
is being added to through such re-search
institutions as the Institute of
Cancer Research of Columbia Univers-ity,
the State Institute for the Study of
Malignant Disease at Buffalo, the Can-cer
Commission of Harvard University,
the Imperial Cancer Research Fund of
England, and hospital and research
organizations such as the Collis P.
Huntington Memorial Hospital, Boston;
the Memorial Hospital, the New York
Skin and Cancer Hospital, and the New
York City Cancer Institute, in New
York City ; the Barnard Free Skin and
Cancer Hospital, St. Louis; the Albert
Steiner Ward for Cancer and Allied
Diseases, Atlanta; the George Chase
Christian Hospital and Clinic, Uni-versity
of Minnesota, Minneapolis ; The
American Oncologic Hospital, Philadel-phia
; The Pennsylvania Cancer Com-mission
; The Middlesex Hospital in
England, and others.
The total number of persons who are
working constantly for the discovery of
new facts which may be usefully em-ployed
in the control of cancer is large.
Many of them are surgeons, others
radiologists, and not a few are out-and-out
research workers giving their whole
time to this work. Unlike quacks who
work secretly and do not take anyone
into their confidence, these students of
cancer are constantly discussing their
results with one another and publish-ing
their findings where all workers in
this field can see and profit by them.
Since 1907 there has been a well-established
organization of scientists
who are engaged in studying cancer,
called The American Association for
Cancer Research. The President is Dr.
Channing C. Simmons, Surgeon of the
Cancer Commission of Harvard Uni-versity,
and the Secretary is Dr. Wil-liam
H. Woglom, of the Institute of
Cancer Research, Columbia University,
New York. This Association has a
membership of 148. The papers which
are presented at the annual meeting
are eagerly awaited by students of the
cancer problem in Europe and America.
They are published in the Journal of
Cancer Research.
What Everyone Should Know
Twelve years ago, our Society was
established to carry on a campaign of
education as a means of turning the
existing knowledge of cancer to the full-est
account. The founders knew that it
would not be necessary to wait until a
complete cure for cancer had been dis-covered
before systematic help could be
given to the 250,000 or more sufferers
from this disease who existed in the
United States and Canada.
The hopes of the organizers have
been fully justified. During the dozen
years of its existence, the American
Society for the Control of Cancer, has
given instruction by means of lectures,
new.spaper articles, radio talks and
other vehicles of publicity in all parts
of the United States and in many of
the Provinces of Canada, and it is esti-mated
that not less than 50,000,000
people have thus obtained their first
January, 1926 The Health Bulletin 17
lesson in regard to this disease. It will,
of course, be necessary to follow this up
with further Instruction. The public
has received some knowledge of the
early symptoms of cancer and has been
told to go immediately to a competent
physician upon the first appearance of
the disease. About 25.0(X) volunteer
workers are engaged in this educational
work in the course of the year. The
Society maintains national headquar-ters
at 370 Seventh Avenue, New York
City, where it is glad to answer in-quiries
on any and all aspects of the
cancer problem.
How Cancers Start
The new knowledge teaches that can-cers
always start in a small way. At
first they are miniature cancers. They
grow slowly and insidiously. Conse-quently,
the person who is attacked by
one may not become aware that any-thing
is seriously the matter for a long
time. A cancer of the skin, for example,
may continue for several years without
causing pain or other marked incon-venience.
Not only is a cancer small to begin
with, but it appears to be a distinctly
local disorder. Present day knowledge
gives no reason to suppose that it is a
constitutional or blood disease. On the
contrary, the weight of evidence is op-posed
to that supposition. No general
disease is in any respect like it. No
disease necessarily precedes it or is
related to it. It often attacks persons
who appear to be in perfect health.
In its early stages the cancer does
not affect the general health nor the
patient's spirits, and this is particularly
true if the patient does not know nor
suspect that he has cancel-. It is only
after the cancer has progressed con-siderably
that the general health is
impaired.
If, while the cancer is small, it is
completely removed by surgery or de-stroyed
with X-rays or radium, or, in
fact, by any other means, that is an end
of it. This could not be so if cancer
were a disease which affected the whole
body.
If, instead of being completely re-moved
or destroyed, the original cancer,
or any particle of it, is permitted to
live, additional cancers are apt to fol-low
either at the original site or else-where.
Thanks to the increasing knowl-edge,
the manner in which this happens
has become more and more apparent.
It has been proved that minute parti-cles
of the original cancer may be car-ried
to variovis parts of the body by the
lymph and blood and there establish
themselves as new cancers. The routes
by which these cancer cells are carried
are often known and in skillfully con-ducted
operations, the places where the
particles may have lodged are attended
to when the cancer itself is removed.
This information is of much value.
A good many deductions of practical
utility have been based on it. One is
that surgery or radiation must be ap-plied
before any migration of the little
particles has taken place, for after this
has occurred the removal of the original
cancer alone will not produce a perma-nent
cure. In early treatment lies the
hope of cure.
Gradually a more and more definite
meaning is being attached to the word
"cure" as applied to cancer. Physicians
are less willing today to say that a
patient has been cured of cancer than
they were formerly. Recurrences from
the growth of particles which have re-mained
dormant for a very long time
may occur. After five years, however,
the chance of recurrence is relatively
small. Consequently, physicians are
coming to measure the success of the
various methods of treatment which
they employ in terms of the number of
five-year cures which have been ef-fected.
Not Contagious or Inheritable
With the increasing knowledge, opin-ion
is becoming more and more securely
settled that cancer is not due to a para-site.
It would be a great step for-ward
if the public would learn to ac-cept
this opinion, for the possession of
it would dispel not a little of the fear
with which cancer is regarded. It would
also help to put an end to the promo-tion
of some "cures" which do not cure,
in other words, quackery, that greatest
of all cruelties, as so many writers
have declared.
If cancer is not due to a parasite,
it follows that the disease is not trans-missible
from person to person. This
18 The Health Bulletin January, 1926
is true of all diseases. It also follows
that a serum cannot be prepared which
will stop it.
It should be generally recognized
that cancer is not communicable, for
a belief that it is infectious has not
infrequently led to the shameful neg-lect
of patients who have had need of
the best care and attention which could
be given to the sick. Persons need have
no fear to live or work near one who
hr.s cancer.
As to the inheritability of cancer, the
general opinion among qualified stu-dents
of this question is that the dis-ease
itself is not inherited, but that
a certain lack of resistance toward it
may now and then exist in a family
for two or three generations. Experi-ments
which have been made in breed-ing
large numbers of mice have led
some i>ersons to get the wrong idea
that cancer or a predisposition toward
it might exist in some families in-definitely.
It is true that by carefully
selecting mates through hundreds of
generations, strains or families of mice
have been produced which are more
susceptible to certain forms of trans-planted
cancer than is commonly the
case, but nothing like such a predis-position
occurs among mice which are
left to mate as they will. The great
difficulty with which susceptibles can
be produced shows that the results ai'e
highly artificial. Apparently they have
no analogy among human beings under
the ordinary circumstances of every-day
life. For practical purposes, it is
reasonable to consider that cancer is
not transmissible from parent to off-spring
among human beings.
The Prevention of Cancer
Within the last few years it has been
found that the inciting cause of cancer
is in practically all instances some
form of chronic irritation. At the site
of the growth there has been for a
considerable time a mechanical, chemi-cal,
bacterial, or other irritating con-dition
which has in some way so dis-turbed
the natural resisting and re-pairing
function of the tissues that they
have at last given way and set out
upon a career of unrestrained and un-restrainable
growth. This theory has
now been so thoroughly investigated as
to be accepted universally as a funda-mental
and completely established fact.
To prevent cancer therefore is to pre-vent
the chronic irritations which lead
to it. One should beware of the broken
tooth or dental plate which continually
irritates the tongue, cheek or gums ; of
the spectacles which make the head
sore behind the ear, on the temples or
nose ; of any sore which will not heal
;
of the mole or wart that changes in
color, size or appearance; of indiges-tion
which will not stop and cannot be
explained ; or any unusual and un-natural
discharge from any part of the
body and of any lump which does not
go away.
When any of these conditions occur,
you should go at once to a capable
doctor and do what he advises. At
once means today. If the trouble is
not cancer, your discomfort will thus
be removed. If it is cancer, your
promptness may save your life. In deal-ing
with this disease, delay is not
merely dangerous : it is fatal.
When Johnny comes for his teeth to
be examined and we find his teeth are
poor and dirty, we teach him to brush
his teeth but we should also find out
why he has poor teeth. It is either one
of two things—either Johnny is poorly
nourished or Johnny's mother has been
poorly nourished before or after
Johnny was born, when she was un-able
to give him tooth-building food.
It is highly important to realize that
we have emotional habits as well as
habits of mind and body. We are
coming to realize the importance of
the psychology of the emotions in re-lation
to mental and bodily health. We
can definitely set for ourselves the goal
of forming habits of happiness, of en-joyment
and enthusiasm in our daily
life, of courage and of generosity
toward the opinions of others. Until
we realize that negative emotional
habits have just as much to do with ill
health as germs, we have fallen far
short of our standard.
—
Patty I. Hilx.
Man's happiness consists in the
means and not in the end ; in acquisi-tion
and not in possession.
January, 1926 The Health Bulletin 19
f
PUBLIC HEALTH NURSING*
20 The Health Bulleti>' January, 1926
be accomplished with systematic visita-tions
by a trained personnel to advise
them regai'ding general and personal
hygiene.
In order to try out his theories in a
practical way and to see whether the
suffering and misery of the sick could
not be alleviated by proper nursing and
home conditions improved by instruc-tions
in hygiene, he employed a nurse
who had been attending his wife, and
at his own expense, obtained her co-opei-
ation in making these visits.
The reports of these visits are most
interesting. We learn that the nurse
was instructed not only to give nursing
care to the sick, but to teach the fami-lies
how to take care of themselves and
of their own sick and how to lead the
proper kind of lives. So here again we
find social service work inevitably
bound up with visiting nursing, the
public-health nurse becoming the social
service worker as well.
The results of this feeble beginning
wex-e so satisfactory that, in 1859, with
the aid of Miss Nightingale, other
nurses were put on dutj' and of course
the work grew.
In reviewing an account of this work,
we have found a tendency and a right
one, to get away as far as possible
from actual medication and to empha-size
to the limit public-health hygiene
and prophylaxis, even though the
knowledge of the prevention of infec-tious
diseases in that day and time was
meager. We read that, in those times,
nurses were "urged over and over
again'' not to pauperize the patient by
giving medical comforts unless they
were actually necessary. Florence
Nightingale also saw this danger and
said : "If district nurses begin by giv-ing
relief they will end by doing noth-ing
but giving relief."
In modern public-health nursing of
today we are, in the same way, caution-ing
the public health nurse not to fall
into the error of practicing, to a great
extent at least, bedside treatment—to
remember that her duty is to preach
prevention and to leave the treatment
end of the disease to the practical
nurse or practitioner.
Public-health nursing in this country
was rather slow in developing. In 1828
Doctor Warrington, of Philadelphia, on-ly
23 years of age, inaugurated the so-ciety
of district nursing. At first it was
merely for the purpose of qualified
nursing attendance to poor women in
childbirth, but the work was gradually
extended to take care of all classes of
cases. The first charter of this organ-ization
read: (to) "Provide, sustain,
and cause to be instructed, as far as
iwssible. pious and prudent women as
nurses, it being understood that the as-sociation
does not confine itself to the
supply of monthly nurses only, but for
every variety of sickness of patients.'"
A district nursing organization was
started in Boston in 1886, and in 1888
the association was incorporated under
the name "Instructive District Nursing
Association," with the purpose not only
of caring for the sick but for giving
them instruction in home nursing and
public health. The objects of the asso-ciation
were stated to be
—
1. To provide and support thor-oughly
trained nurses who, acting
under the immediate direction of
the out-patient physicians of the
Boston Dispensary, shall care for
the sick poor in their own homes
instead of in hospitals.
2. By precept and example to
give such insti'uction to the fami-lies
which they are called upon to
visit as shall enable them hence-forth
to take better care of them-selves
and their neighbors by ob-serving
the rules of wholesome liv-ing
and by practicing the simple
arts of domestic nursing.
So, again, we see that the idea of
public-health instruction as a funda-mental
and most important duty of
public health nursing was all promi-nent.
This phase was being gradually
accepted by all as the most sensible
way of carrying on public health nurs-ing,
the nurse thinking more of the
community as a patient than of the
individual sick.
In 1893 Isabel Hampton, in an ad-dress
to the International Congress of
Nurses, said
:
In district nursing we are con-fronted
with conditions which re-quire
the highest order of work,
but the actual nursing of the pa-tient
is the least part of what her
work and influence should be
among the class which the nurse
January, 1926 The Health Bulletin 21
will meet with. To this brauch of
nursing: no more appropriate name
can be given than "Instructive
nursing,"' for educational, in the
best sense of the word, it should be.
The first special work in district
nursing was undertaken in London in
1892, when a staff of visiting nurses
was organized to visit the schools and
inspect school children. However, the
honor of inaugurating school nursing
in America is due to Miss Wald. found-er
of the Henry Street Settlement, who
in 1902 suggested the use of nurses to
supplement the work of doctors in the
schools of New York. Medical inspec-tion
of school children had been in
vogue in the schools before that time,
but it was merely a perfunctory exami-nation
by a physician, the only thing
accomplished being the exclusion of the
child, nothing being done to prevent
the cause of the illness, or a visitation
at the homes of the school children to
carry the principle and gospel of pre-vention
of disabling illnesses.
During these times of demonstrations
in public health nursing and the ai'ous-ing
of public interest in these demon-strations,
gradual progress was being
made in the requirements of those who
wi.shed to enter the nursing and medi-cal
professions. While nursing was
reaching the plane which it has now
attained as a profession, wonderful
strides were being made in the medical
profession toward the prevention of
diseases, such as the use of antitoxin
against diphtheria, inoculation to pre-vent
typhoid fever, and the valuable
work now being carried on toward the
standardization of antitoxin against
scarlet fever. The dangers of neglected
teeth, the tonsil and adenoid evil, and
the value of scientific baby care began
to be considered by the laity along with
their previous ideas of safeguarding the
health of cattle and hogs.
Dental prophylaxis, the outline of
programs for prenatal hygiene, and the
development of intensive school pro-grams
are all accomplishments which
demand highly trained nurses in the
public-health field for service in all
recognized full-time health departments.
In the early history of public-health
nursing we find that it had its incep-tion
in centers of population — the
cities. Those who lived in the country
and in rural districts were indeed
deemed fortunate. Living in the coun-try
(and the same idea has held to the
present day) was thought to be a pro-tection
against sickness. For this rea-son
public health of rural communities
has been, and still is, greatly neglected.
Thirteen years ago there was not one
full-time county health department in.
the United States among the three
thousand and odd counties composing
this country.
We finally awoke to the fact that a
real health problem existed in the coun-try,
and one of even greater importance
than the urban health question. The
death rate was higher, the morbidity
index was higher, and the rural dweller
did not have a protected water supply,
a protected milk supply, or proper
methods of sewage disposal, as pro-vided
by ordinances in cities. There-fore,
he drifted along by himself, con-tracting
typhoid fever from his own
water supply, polluted by his own sew-age,
and blaming the causation of the
disease on God. the devil, tin cans,
weeds, or whatever came to his mind.
It took us a long time to realize these
things, but since that realization full-time
county health units have been
organized and are in operation in over
280 counties in the country, with new
ones developing every year through the
financial cooperation of the Unite<i
States Public Health Service, the In-ternational
Health Board, and the State
boards of health.
I know of no greater service in pub-lic-
health nursing than is given by
nurses working in full-time county
health units. Nor do I know of any
better way in which a nurse can pro-duce
real service in virgin fields than
in this branch of nursing work, which
in itself is a specialized branch of the
profession.
Just because an individual has M D.
after his name is no index at all that
he will make a health officer ; just be-cause
an individual has R.N. after her
name is no index that she will make
a good public-health nurse. In both
instances it is ab.solutely essential that
certain periods of training and practi-cal
experience be undertaken before the
proper qualifications can be attained in
this special field. The great difficulty
22 The Health Bulletin January, 1926
experienced in the development of full-time
county health departments is to
find properly qualified public-health of-ficers
and properly qualified public-health
nurses.
The part which the public-health
nurse of today plays in the general
scheme of full-time health service—mu-nicipal
or rural—is elaborated very
• much in detail in a report of the "Com-mittee
to Study Visiting Nursing," in-stigated
by the National Organization
for Public Health Nursing, with the as-sistance
of the Metropolitan Life Insur-ance
Co.
This committee, in an effort to valu-ate
the present status of visiting nurse
associations and learn their cost, made
a study of public-health nursing in 14
communities in various localities of the
United States, including rural nursing
as well as work in large and small
cities. The various types of nursing
work carried out in the various cities
were as follows
:
Maternity nursing:
Prenatal.
Delivery.
Postpartum.
Infant welfare.
Child welfare (preschool) :
Orthopedic.
Nutrition.
School nursing.
G neral medical and surgical nursing.
Acute communicable disease nursing
:
Tuberculosis nursing.
Venereal disease nursing.
Health education.
Industrial nursing.
Nursing of chronics.
Mental hygiene.
In the summary of conclusions and
recommendations in this exhaustive re-port
it is recommended that
—
1. Every agency should have an
established routine for introducing new
nurses into the work of the agency.
2. In addition to the initial period,
there should be a more or less continu-ous
staff educational program.
3. Adequate supervision is essential
to the efficient admiqistration of every
public health nursing agency.
Of course there are other recommen-dations
regarding the cost of nursing
and routine methods of operation, but I
mention the above to emphasize that, in
present-day programs, there is a con-tinual
cry for well-trained personnel,
in realization of the fact that public-health
nursing is indeed a separate and
distinct specialty of your profession.
Last year the United States Public
Health Service, through Miss Lucy Min-nigerode,
superintendent of nurses, sent
a questionnaire to all State depart-ments
of health, in order to obtain in-formation
as to the status of public-health
nursing as it is carried on by
the several States.
It was learned that 17 States and the
Philippine Islands have separate divi-sions
or bureaus of public-health nurs-ing
; 8 States have bureaus of public-health
nursing and child hygiene com-bined
; 10 States have only bureaus of
child hygiene; and 11 States and
Alaska have no bureau of nursing of
any description. A few .States were
not heard from.
The duties performed by the nurses
in these State health departments in-cluded
the follo\\'ing:
1. Child health conferences and dem-onstrations.
2. Organization of volunteer services.
3. Classes for midwives and mothers,
with prenatal instructions.
4. School nursing, physical examina-tion
of school children, inspections.
5. Health educational work and
health talks.
6. Follow up of clinic and school
cases.
7. Maternal and infant hygiene under
the Sheppard-Towner Act.
It might not be amiss to give verba-tim
a few quotations from some of the
State health otiicers regarding their
ideas of public-health nursing as an aid
in the State health program. One health
officer said
:
"Public-health nursing is an in-dispensable
aid, since the success
of the entire program depends upon
education of the public, and the
public-health nurse is the best
teaching agent we have yet found
for dealing with individuals and
families in the home."
Another said
:
"Next to an efficient director, an
efficient public-health nurse is the
January, 1926 The Health Bulletin 23
most important part of any public-health
unit."
Still another
:
"It would take a manuscript to
answer such a question as this."
And another
:
"Much of the program of the
State board of health is made pos-sible
through the cooperation of
local public health nursing ser-vices."
With the need for public-health
nurses, which we all can appreciate to-day,
it is hoped that the time is not
far distant when theoretical and prac-tical
teaching in the public-health field
will be a part of the nurse's training.
At least the problem can be given to
the probationer ; and if she feels the
call of the public-health field, provision
should be made to have her located
with successfully functioning units, in
order to get practical training to sup-plement
her lectures.
A start has been made in courses in
public-health nursing which are in
vogue at certain universities in the
country ; but the number offering these
facilities is certainly all too few to sup-ply
the demand now existing for this
type of health endeavor.
In the work of a State board of
health, the fundamental problem is the
rural one. For that reason much con-centration
and labor are being ex-pended
in the development of new full-time
county health projects and the
standardization of those now in opera-tion.
No rural health unit is complete
without a nurse or nurses on the staff.
The duties of these nurses are familiar
to all of you—visits to schools, assist-ing
in the inoculation and vaccination
of school children, visits to contagious-disease
cases, assistance in the keeping
of records, giving health talks, and the
like. With these duties it is all-impera-tive
that the rural health nurse develop
an attitude of social service.
Social service has been a much mis-used
term because its practical applica-tion
has not been conducive to the
best results, at least in some places.
Certainly social service has a place in
the public-health nursing program. But
all too often we are prone to think of
social service in terms of social uplift.
The average person visited resents any
attitude on the part of the visiting
agency implying that he needs to be
uplifted socially, and we can hardly
blame him. Social service should carry
with it a neighborly and friendly ad-vice
which will help the family out of
their difficulties. For example, a visit-ing
nurse finds a case of tuberculosis
in a family. The wage earner in the
family goes to work every day in the
factory and is in such a condition that
tuberculosis might easily develop. It is
not enough merely to say that the in-dividual
should seek another line of
work where he would not be subjected
to the stifling atmosphere of the fac-tory.
Real social service goes a step
farther and tries to find for that man
a position which would be best appli-cable
to his case.
It is not meant that real social-ser-vice
work should be the crowning duty
of the public-health nurse, but a part
of her duty which is so interwoven and
so cemented with her work that she
cannot escape it. This is especially so
in the communities in which we are
laboring.
In our enthusiasm for better rural
health work, there is always the danger
of overdeveloping specialized health
service. I have been in counties where
I have found a nurse attached to the
county health unit doing routine work
;
a nurse on duty with the tuberculosis
association, looking up tuberculosis
cases for specific diagnosis ; a nurse
placed on duty especially by the public
schools of the county for the purpose
of school inspection ; a nurse represent-ing
the Red Cross; and, in some places
the Metropolitan Life Insurance Co. is
doing most valuable work in the public-health
units among the policyholders
of its company.
The result of this specialized, official-ly
uncorrelated service is confusing and
overlapping; and, in my own mind,
there is a question as to whether the
maximum results can be obtained by
such service. Only recently I was talk-ing
to the health officer of a large city
where various agencies were carrying
on public-health work in this way. I
was told by him that, in one day, a
home which occupied a rather strategic
position just outside of the city was
visited by five different nurses. I can
24 The Health Bulletin January, 1926
imagine the feeling of the householder
when the fifth nurse arrived. One
visit should have been enough to ob-tain
all of the information that all of
these different agencies wished to learn.
It is not desired that the individual-ity
of these different organizations be
taken away, but it is essential at least
that they report their findings to the
county health board or the county
health officer as the case may be. If
the health officer wishes a case of tu-berculosis
investigated, there does not
seem to be any valid reason why he
should not call upon the tuberculosis
nurse or the Red Cross nurse to assist
in the work, and no valid reason why
the nurse placed on duty by the school
board should not assist in the school
examinations.
If this correlation existed, we would
find, in many counties, smoothly work-ing
machines with an adequate nursing
force to take care of all their needs.
As a matter of fact, in one of our
Western States last year the county
tuberculosis association actually amal-gamated
with the county health unit
in the support of its program and for
the better attainment of the purposes
of both the county health unit and the
county tuberculosis association.
As yet public-health nursing is in its
infancy. The future holds unlimited
service for this branch of your pro-fession.
The difficulty is to find the
workers ; and it is our duty as public-health
workers to present this problem
before the nursing profession with a
plea for the "trained" worker. This
plea has been continuous from the days
of the early church ; it is urgent now
and will be ever sounding in the future.
(Note: An abstract of "Evolution of
Public-Health Nursing," by Annie M.
Brainard, furnished some of the his-torical
data used in this article.)
LOOK TO WHOLESOME HOME ENVIRONMENT
Many a home environment which to
the superficial student might possess
the appearance of being wholesome is
detrimental, declares Dr. Joseph H.
Marcus, who writes about the dis-obedient
child in the December Hygeia.
Parental solicitude for the child's
welfare may be carried to such ex-tremes
as to undermine the physical
state and lay the foundation of appre-hension,
dread, sluggishness and torpor.
Because of this subtle interaction be-tween
the child's individual constitu-tion
and the ideas and ideals generated
in his home atmosphere, the familial
factor must at all times be cautiously
viewed when interpreting the manifes-tations
of the child.
Impressions register on the infantile
brain, even though in an immature
manner, and of sufficient depth to
create a more or less lasting impression.
The spoiled baby will cry for a defi-nite
purpose ; he may wish to be picked
up. When he is lifted from the crib,
his cries cease with the first sensation
of motion. When the 2 a. m. feeding
is eliminated, the infant manifests his
desire for the accustomed feeding by
arousing the household. If a bottle of
water or an attitude of healthy in-attention
is substituted, the baby is im-pressed
with the fact that his w'hims
will not be responded to ; soon he will
accept this change of routine as a mat-ter
of course and go to sleep.
Good Habits Formed in Cradle
In the cradle lies the foundation of
regularity in habits, and responsive-ness
to sound habits. The human in-fant,
in spite of the potentiality which
he carries with him to develop into the
reasoning adult, is by far the most help-less
and dependable of infants ; he is
subject not only to his own laws of
development, but to experimentation
with certain doctrines on the part of
untrained parents.
Parents Are Untrained
Parents have access to a mass of
trashy literature on the subject of
bringing up children ; this literature
usually ignores the fact that no two
children are quite alike in all respects
and that no method of child rearing has
been devised which would meet the
requirements of all cases.
It may be difficult to train a child to
take nourishment, to attend his physi-cal
functions at certain convenient
intervals, to go to sleep naturally with-
January, 1926 The Health Bulletik 25
out the necessity of lulling influences
such as swinging the bed or rocking the
cradle. These babies from earliest in-fancy
may manifest a certain amount
of stubborness which becomes more
firmly rooted with the passing of time,
so that with the advent of childhood
the negative phase is implanted with
great depth, owing to the extreme flexi-bility
in the parental attitude. These
wilful, but otherwise normal, children
dominate their parents with powerful
traits inherent only to them and obvi-ous
before the period of connected
articulation. These children are even
more commanding when their helpless-ness
is accompanied by a few meaning-less
tears. They are obstinate, but their
wilfulness should be opposed by in-creased
stubbornness in the parent.
Parents Need Instmction
The situation created by these nega-tive
children necessitates instruction of
the parents, in order that they may
appreciate the point of psychology in-volved
and help in eradicating the
maladjustment.
In order to combat the negative atti-tude,
parents should relegate themselves
more to the background, allowing the
children free play. If punishment is
necessary, the storm must be weathered
by all means. The child should be
lauded for his good qualities and should
be told about those qualities which
parents wish him to achieve.
The child cannot too early be taught
to face reality and learn to appreciate
the fact that life is a process of adjust-ment.
Training the infant in regular habits
is essential to a happy adaptability in
childhood and adolescence ; displaying
an attitude of stubbornness more forci-ble
and lasting than the child will
eliminate many negative traits ; healthy
inattention is an excellent form of
medication.
CHILDREN SPOILED BY TOO MUCH LOVE
The most essential thing to the child's
mental well-being is a happy relation-ship
between the parents, says Dr.
Smiley Blanton, who tells about the
Minneapolis Child Guidance Clinic in
the December Hygeia.
Parents who are glossing over, for
the sake of the child, a real antagonism
for each other are rarely capable of
the evenness of discipline and coopera-tion
necessary to the child's develop-ment.
But unkindness or lack of love for
the child are often not a bit more
destructive than too much love and
solicitude.
Sometimes parents are more demon-strative
toward one child than they are
toward another. Even though they may
not love one child more than the others,
they often pet and brag about him
more.
A girl, 5 years old—a very moody
child—became seclusive and unhappy
and no longer cared to play with chil-dren,
but sat brooding, and even weep-ing.
Careful study of the home situa-tion
showed that this girl felt herself
neglected by her parents because her
younger sister, who is superficially
brighter and more vivacious, received
all the attention from the teachers,
neighbors and relatives.
If such a condition had been allowed
to go on the older child might have
grown up with a marked feeling of
jealousy toward her younger sister
;
moody, unhappy, and perhaps bitter to-ward
every one.
Nagging Brings Negativism
Another interesting case was that of
a little girl who was absolutely nega-tive
to all commands. It was difficult
to understand the extreme negativism
of this child until we obtained a whole
record of the family situation.
The mother was an anxious person
and nagged the children constantly. As
a result of this, the child not only re-fused
to obey any commands, but al-ways
did the opposite of what her
mother told her to do.
This attitude on the part of the child
was a perfectly normal one under the
circumstances. It was the only way
she had of defending her personality
against the constant nagging and flood
of unwise commands.
26 The Health Bulletin January, 1926
THE IMPORTANCE OF BEING A PARENT
By D. a. Thom, M.D.
To the child the parent should be
companion, friend, and confidant. The
parent whose little child brings all his
troubles and doubts to him for solution
has established a relationship of tre-mendous
value. This can never be
brought about if the parent's attitude
is cold and repelling. A mother who
is too busy to bother with a little
child's nonsenses will never be bothered
by his real problems.
A child should be treated with as
much courtesy as an adult. Children
have affaiis and plans of their own
which they are following. These plans
are frequently utterly disregarded by
the "grown-up." If they must be inter-fei'ed
with, let it be with some explana-tion
and consideration for the children.
The small daughter of a young couple
was playing contentedly on the hearth
by her father's feet when her mother
called from upstairs for her to come
to bed. Two or three oiinutes more and
Betty could have completed the task
she had in hand and, had mother known
this, she would have waited before call-ing
her. With a quivering chin and
eyes filled with tears Betty turned to
her father saying, "But, Daddy, I don't
want to go. I want to finish." Father
could see the little girl's point, and his
answer was, "That's too bad, Betty.
Mother didn't know how near through
you were, or she would have let you
finish ; but never mind, 'orders is
orders,' so run oft to bed." And off she
went. In this way he showed that he
sympathized with her in her disappoint-ment
and that he expected her to meet
it bravely, and he also upheld the
mother in her request—all in a con-siaerate,
understanding way.
It might here be said that one of the
fundamental . rules of child training
should be that parents present a united
front to the child. If differences in
judgment occur, let them be settled in
private.
There is no finer or more important
job than being a parent. This genera-tion
or the next will not handle it per-fectly.
There is a great deal to learn,
but much will be accomplished if the
approach to the problems of childhood
is not blocked nor impeded by anger,
fear, over-solicitude, or the idea that be-ing
a parent means at all times being
obeyed. Kindness, common sense, and
an effort to understand the child's own
attitude toward his difliculties will do
much to bring about an intelligent
solution for most of the problems.
"The Bible says there is gnashing of
teeth In hell. If these were sound
teeth the outlook would not be so dis-couraging;
but most people have de-cayed
and sensitive teeth before they
get to their final reward, and gnashing
these doubtless serves to make hell live
up to the advance notions."
NO VENTILATION—SIX LIVES LOST
Recently in a village in the eastern
part of the State volunteer firemen,
arriving at a burning bungalow shortly
after midnight, are reported to have
found every window tightly closed and
securely fastened and the rooms fes-tooned
with soot, presumably from two
kerosene heaters. Huddled in corners
were the bodies of the owner, his wife
and four children. A fifth child, a girl
of sixteen, escaped by breaking the
glass in one of the windows.
From such evidence as can be gath-ered
it appears that a visitor left the
house about an hour previous to the
time when the flames were discovered
;
that the family then retired leaving
the two kerosene heaters burning and
that no provision for ventilation of the
bed-rooms was made. From the loca-tion
of the bodies it is probable that
the victims were partially asphyxiated
when aroused by the flames.
Whether or not the evidence as here
recorded is in accord with the facts
will probably never be known. The
tragedy, however, should indelibly im-press
two health rules on the mind of
every person in the State, namely:
never to retire without first extinguish-ing
every flame except those in stand-ard
heaters, stoves or ranges, and
second, to have adequate ventilation
in bed-rooms during hours of sleep.—
Health Netcs, N. Y.
January, 1926 The Health Bulletin 27
CARE OF THE TOOTHBRUSH
Very few people know how to care
for a toothbrush.
When buying a toothbrush gret one
that is small enough to reach the back
surface of the last tooth in the mouth
and that will go under the tongue when
cleaning the inside surfaces of the
lower teeth.
After using the brush rinse it well
;
warm water, not hot, is best because
all tooth powders and pastes have soap
in them. Tooth paste has glycerine in
it. These materials as well as the dirt
and food left on it from the brushing
should be washed out of the brush.
Hang the brush in a clean, dry, and
if possible sunny place. Never keep
toothbrushes in a dusty dark corner.
Cleanse the brush once a week. The
best way to do this is to moisten the
brush, and fill the bristles as full as
possible with common salt. Then place
the brush in a clean SUNNY spot. The
chemical action produced by the sun,
sterilizes the brush without ruining it
as boiling will do.
Many people keep two brushes in use
all the time. This method is very good
for those who do not like to use a
soft brush. By being used every other
time the brushes have plenty of time
to dry and the bristles to stiffen.
Discard any old brush that has be-come
caked with dirt and tooth paste,
at the base of the bundles of bristles.
—
Connecticut Health Bulletin.
SEX HYGIENE
The most important act of a liv-ing
thing is the reproduction of
itself. With its death all its interests
stop, and nothing matters. With its
reproduction its interests continue
and give things their meaning. We
have a long history of human life
since Adam. It has been a continu-ous
thing every moment since the
beginning. But the long span of life
has been lived only a generation at
a time, by men and women who live
only a comparatively short time.
The continuation of life depends upon
the renewing of it every few years.
The sex act is the act by which
the individual reproduces himself.
It is the act which stops or continues
life. And sex health largely deter-mines
the quality of life which is
passed on. As a link in the chain of
the race, the boy and the girl are of
sufficient importance to justify the
use of any terms which are necessary
to give them the information about
themselves that they need in order
to understand themselves and to
solve their sex problems wisely. It
is the duty of parents, teachers and
physicians to give them this infor-mation
early enough in life to make
sure that they get it from intelligent,
clean and serious people rather than
from ignorant, lewd and frivolous
ones, as they often do. As soon as
the child manifests curiosity about
such matters he should be told the
simple truth, plainly and honestly.
The lowest forms of life have only
one cell, like a house of one brick.
These forms reproduce by simple di-vision
of one cell into two cells. No
part dies or is lost.
As we go up the scale we come to
a type in which two cells unite and
fuse to form one cell. This new cell
then divides and redivides to form
a greater number of cells.
In still higher types the cells do
not separate, each to itself, when
they are split off, but stick together
and arrange themselves, like bricks
laid to form a house, according to a
plan, to form a body like our own or
like a tree. Then male and female
types appear, and each one sets aside
special cells to fuse with the special
cells of the other. This fusion forms
the new cell from which the new
body grows.
In the springtime the oak tree has
two kinds of flowers One kind pro-duces
the pollen or male cells. The
other kind produces the female cells.
The wind dusts the pollen on the
female flower and the male cell com-bines
with the female cell. A new
cell forms and during the summer
it develops into a small tree, so
small that it is closely folded inside
a thin shell, which is developed
around it, and by fall it is an acorn.
28 The Health Bulletin January, 1926
The acorn is a small tree in a shell
waiting for the proper conditions of
the warmth and moisture of spring
to make it burst its shell, sprout and
grow.
In chickens the rooster carries the
male cell and the hen carries the
female cell. By the union of these
two cells in the hen a new cell is
formed which collects yolk and white
around it for food, and encloses it-self
in a shell. In this form as a
finished egg, it is laid by the hen.
If this egg is kept at body tempera-ture
by a hen or an incubator the re-productive
cell in the egg grows,
uses up the yolk and white of the
egg for nourishment and in three
weeks, steps out of the shell as a
new chicken.
In human beings the man carries
the male cell and the woman the
female cell. In the sex act the male
cell is deposited where it finds its
way to the female cell in the womb
of the woman where the two cells
unite to form a new cell from which
a new baby grows. Instead of three
weeks, as in the case of the chicken,
in nine months a new baby steps out
into the world. It is supplied with
warmth and nourishment from the
mother during this time. Birds,
beasts and human beings all grow
from a single cell, formed by the
union of a special cell each from the
male and the female.
The sex organs of the man are the
testicles in the scrotum, the seminal
vesicles at the neck of the bladder
and the penis. The male cells for
reproduction are produced in the tes-ticles
along with a secretion which
carries them up into the seminal vesi-cles.
In the sex act the seminal
vesicles contract and force the secre-tion
containing the cells for repro-duction,
out into the urethra, through
the penis to the entrance of the ute-rus
of the woman.
The sex organs of the woman are
the uterus, a hollow muscular organ;
two tubes, one on each side of the
uterus, each leading from the cavity
of the uterus to an ovary in each
flank. The ovaries in the woman
correspond to the testicles in the
man. They produce the female
cells for reproduction. These cells
pass from the ovaries through the
tubes to the cavity of the uterus. In
or near the cavity of the uterus the
male and female cells meet. They
fuse to form a new cell. The new
cell grows and forms a new baby.
Now, that we understand the struc-ture
of the sex organs, what will be
the result if they become diseased?
In the man, if the testicles are dis-eased,
no cells will be produced. If
the passages are closed by disease,
the cells which are produced in the
testicles cannot get out. And the
man cannot become a father. In the
woman, if the ovaries are diseased,
no cells will be produced. If the
tubes leading from the ovaries are
closed by disease the cells which the
ovaries produce cannot get out. And
the woman cannot become a mother.
The disease which most often
causes these conditions is gonorrhea
(clap). In the man it begins in the
urethra and spreads backward to-ward
the sex gland. It does not al-ways
go this far, but it often does,
and the consequences is castration.
In the woman it begins in the ure-thra
or in the entrance to the uterus
and spreads upwards to the tubes
and from the tubes outward to the
ovaries. This is the usual course in
women. The tubes become sealed
off at both ends. Not only are the
cells from the ovaries prevented from
reaching the uterus, but the middle
of the tube sealed off at the ends be-comes
an abscess. Then she is a
sick woman for life. An operation
is the only cure, and in the operation
it is often necessary to remove the
ovaries with the tubes.
Many of the tragedies of innocent
married women are due to the mis-takes
of well meaning but mistaken
husbands. Men who have had gonor-rhea,
but think that they are cured,
marry with all feeling of safety. But
in a year- or two a wife with one
child or with no child at all fades
and possibly becomes an invalid from
sexual derangement. The man who
thought he was well had the living
germs of gonorrhea sleeping in his
sex glands and in his sex acts they
were thrown out and passed into the
uterus of the woman. He has unin-tentionally
given her the disease and
January, 1926 The Health Bulletin 29
she and his children bear the penalty
of his infection.
Syphilis is a disease which is usu-ally
transmitted in the sex act. It is
a constitutional disease which affects
the entire body and in its last stages
it causes disease of the heart and
arteries, and paralysis and insanity
which are incurable. It is the dis-ease,
spoken of in the Bible, which
visits the sins of the father upon the
third and fourth generations.
The sex energy is the most vital
energy of a living thing. In a man it
determines whether he shall be a
master or servant. A colt that is
sexually healthy develops into a high
grade spirited, strong horse that car-ries
an arched neck and is anxious
for a race. If a boy is castrated he
will not make a successful football
player nor lead his class in school.
He lacks the secretions of his sex
glands, which, if absorbed into his
circulation would stimulate his
nerves and brain and furnish him en-durance
for hard work. If a boy
spends his sex energy by self-abuse
or in other sexual dissipation, the
same thing happens. The vitality
which should go to build nerve, brain
and brawn is wasted. _Such men can-not
father the strongest sons, and
they themselves are not the leaders
in their own communities. Until
marriage all energy should be di-verted
into channels of study and
training for the fullest development
of the body and the brain of the in-dividual.
After marriage it will be
divided between reproduction and
the using of the faculties which he
developed before his sex life began.
Then when his sex life begins he is
reproducing himself at his best. And
the race is much stronger as the re-sult
of the sex suppression, and the
full development of the mind and
the body of the individual before he
turns his attention to his sex life.
The company of fast and immoral
people is unprofitable because it
arouses passions which should re-main
asleep and arrests mental de-velopment.
It costs you your most
valuable energy, for which there is
nothing in return. In addition to
arresting your development and dis-sipating
your energy, it may incur
disease which will destroy your abil-ity
to become a parent. If girls are
"fast" with you they are probably
"fast" with others, although they
may be clever enough to keep you
from thinking so. Practically all
prostitutes have gonorrhea or syph-ilis
or both. Many men have no chil-dren
or have blind and deformed
children as the result of only one
such party.
A thing which is often misunder-stood
and which quacks make much
of, is seminal emissions at night. An
occasional emission in the case of a
man of clean life is perfectly normal.
If the bladder becomes overfilled
with water during sleep it presses
upon the vesicles and may produce
irritation enough to cause them to
empty themselves. If there has been
sexual excitement which overfills the
vesicles with semen the discharge is
still more likely to occur. If under
such conditions the individual drinks
coffe or whiskey or other stimulants
which fills the bladder with urine
and increases the irritability of the
seminal vesicles a night seminal
emission is even still more likely to
occur. As many as three or four
emissions may occur monthly without
meaning anything abnormal, al-though
some people do not have them
at all. A temperate life of regular
habits of eating, sleeping, bathing
and exercise, and avoiding sexual ex-citement,
is the best way to prevent
them.
No child should be permitted to grow
up with a physical handicap which
modern science can correct. Every
child is entitled to a fair chance to
make his way among his fellows with-out
the limitations of which accom-pany
a conspicuous, unsightly or dan-gerous
deformity or defect.—C. N.
Johnson, D.D.S., President-elect Ameri-can
Dental Association.
The study of healthful living must
be more than personal and public
hygiene concerned with physical and
bodily health ; it must also deal with
healthy mental life; and t( be complete
it must touch sound health or social
welfare of society.
—
Db. Mavbice Bige-
LOW.
30 The Health Bulletin January, 1926
THE STORY OF THE BATH
Mr. Lewis W. Britton, associate
editor of the Domestic Engineering
Publications of Cliicago, recently pre-pared
for the New York State De-partment
of Health "The Story of
the Bath," which relates in semi-humorous
vein the history of bath-ing
from early times to the present.
"This is not a bedtime story," said
Br. Britton. "It is a bathtime story.
Do you ever think, as you slip grace-fully
on the soap, that the history of
your bathtub reaches back into the
days before people had soap on
which to slip? There are, of course,
stories of the bath that aren't true.
I refer to the stories young boys tell
of baths they take when not under
a watchful eye.
"When Egypt wore the crown of
civilization, the Egyptians were fre-quent
bathers; when Greece was the
glory of the world, her bathing was
the glory of the Greeks; when all
roads led to Rome, all feet led to
the Roman baths.
"In Japan where everybody takes
a bath a day and apologizes for not
taking two, progress moves at a
swift pace. In Russia, where mil-lions
of people get only three baths
in their whole lives—one after they
are born, one before they are mar-ried,
and one after they die—there
is stagnation, poverty, misery.
"So far as we know, the first bath-room
was in the city of Cnossos, on
the island of Crete, four thousand
years ago. The ruins of a much later
model, dating back only twenty-five
hundred years, have been found in
Tirgus, which is in Greece.
"The Greeks were the first to use
bath tubs, though the tubs they used
were not tubs at all. They were
bowls—overgrown punch bowls, you
might say, which rested upon pedes-tals
three feet high. They were large
enough to hold the water for a bath,
but not large enough to hold the
bather. The bather stood on a stone
slab, dipped water from a bowl and
poured it over his body. The Greeks
regarded warm water as weaken-ing
—'effeminate' I think they called
it—and so they took their baths cold.
"Among other things, Moses taught
hygiene, sanitation and the fine art
of living. He knew that to keep
clean is to prevent disease, and to
prevent disease is to build a strong
race of people.
"The Roman bath was called Ther-ma,
meaning heat, from which we get
thermos—thermos bottle. The Ther-mas
did not have canned music, elec-tric
lights nor ash trays, but in mag-nificence,
they outshone any club of
this year of peace and plenty.
"Rome knew only two classes of
people—the washed and the un-washed.
And then, as now, the un-washed
were crowded beyond the pale
of polite society.
"The largest Therma covered a
square mile of ground. The huge
Diocletian could take care of thirty-two
hundred bathers at one time,
while the Caracalla, the finest of
them all, had room for half as many.
Besides hot and cold baths, the Ther-mas
were provided with perspiring
rooms, dressing rooms, swimming
pools, athletic fields, gymnasiums,
lecture halls, and places for rest, re-freshment
and conversation. And
there were Thermas for women as
well as for men.
"In those public baths the Romans
exercised, kept their bodies clean,
stimulated the circulation of their
blood, rested, enjoyed the compan-ionship
of their fellows and fed their
souls with beautiful carvings of an-cient
sculptors—all for one quad-rans,
which in Uncle Sam's money, ,
would be one-fourth of one cent.
"For six hundred years, so Pliny,
the historian, says, Rome used no
medicines but her baths.
"A real Roman cleansing consisted
of a sweat, a scrape and a shower.
Or, as the invention of the shower !
was yet to be, perhaps 'pouring' is
a better word. That is, after a sweat
and scrape, water was poured over ,
the body until it was washed clean, j!
Then came a massage or rubdown, \
followed by a good rest. Thus from i
Rome, by the way of Turkey, arrived
j
the Turkish bath, which finally
|
reached America in 1865.
i.
January, 1926 Thk Health Bulletix 31
"A clean nation is a progressive
nation, and a progressive nation is a
ruling nation. But alas, alack, the
thirst for power—the spirit of con-quest
reaching out and out for more
and more—and Rome crumbled, and
progress crumbled with her. And
the world went to sleep and slept for
a thousand years, or to say it in an-other
way, a thousand years without
a bath.
"A thousand years without a bath.
Surely those were Dark Ages—dark
with dirt. But wait:
"The Order of the Bath, from
whence emerged the Knights of the
Bath, was a little pleasantry set
agoing by Henry the Fourth of Eng-land
in the year thirteen hundred
ninety-nine. But was it a pleasan-try?
One can never tell about an
Englishman. Henry may have been
serious. He lived in a serious time,
and serious times make serious peo-ple.
Europe was beginning to run
its eyes and creep out of the filth of
ten mouldy centuries Perhaps King
Henry thought it time to wash up,
which is to wake up.
"In days of old, the knights were
bold," so the poet wrote—but not
bold enough to take a bath. Henry
knew this. He knew that a knight
shied at water like an elephant shies
at a mouse. Hence the Order of the
Bath.
"Candidates for this order were
selected by the King. But, before
a candidate could be initiated, he
must take a bath. Ah! there was the
rub!
"Having been led into the bath,
and having survived the shock, the
knight became a shining example to
others, who, though less favored,
were equally in need of water.
"More than three thousand years
after Moses went up into the moun-tain
and forgot to come back, another
teacher, John Wesley, the first Meth-odist,
was riding along a road in
England when he came to the dirty
little village of Burslem.
"It so happened that in Burslem
there lived a poor, lame potter by the
name of Josiah Wedgwood. This
potter was to become the richest man
in England, who up to that time had
made his own fortune; also, he was
to become the grandfather of Charles
Darwin, the world's greatest scien-tist.
"Now Wedgwood was a worker
who mixed much teaching with his
work. John Wesley drew rein as he
saw Wedgwood trying to teach his
potters the lesson Moses had tried to
teach—that keeping clean increased
health, which increases energy, which
increases efficiency. And there, sit-ting
on his horse, and seeing what
he saw, Wesley spoke for the first
time the now famous phrase: 'Clean-liness
is next to Godliness.'
"And Wedgwood looked up, smiled
and added: 'Yes, and sometimes it is
next to impossible.'
"Great as we are, and smart as we
are, we Americans have not moved
so fast, sanitarily speaking. It is
only a hundred years since the first
pumping station in this country
started to pump. Chicago was our
first city to have a real sewerage
system, and that was not until 1855.
We had no public baths until 1891.
Even today some families think so
little of their bath tubs that they
use them for coal or vegetable bins.
"The science of living, or sanita-tion—
they mean the same—has to
do with heat, light, water, cleanli-ness
and ventilation. And these have
to do with the five most important
things of life—comfort, health, am-bition,
efficiency, happiness. Where
sanitation is a stranger, sickness is
a constant guest."
It has been wisely said that spite
and ill nature are the most expensive
luxuries of life.
We are continually in the presence
of disease germs ; almo.st daily we are
exposed to contagious or infectious
diseases, yet the body in health is able
to protect itself and ward off the casual
agents of disease. The first general
biological law or general attribute of
living matter is that of self preserva-tion.
The first biological acts of living
protoplasm are, therefore, nutritional.
For perfect health there must be ap-propriation,
assimilation and elimina-tion.—
Dr. Charles Clyde Sutter.
FOR 1926 I RESOLVE
IN ALL WAYS
TO GUARD MY HEALTH
AND
TO DISCOVER
WAYS AND MEANS
OF BECOMING
HEALTHIER AND HAPPIER
AND THEREBY
BE MORE USEFUL
TO MYSELF AND THE STATE
Putli5\ed h^ T/m N°KJI\ Qf^Lm^ 5TATL E)<?ARD s^AEALTA
This Eiillelin. will be serxlfree to ar\-g citizen of "the 5tcrteupoATequest|
Entered as second-class matter at postoffice at Raleigh, N. C, under Act of July 16, 1894,
Published monthly at the office of the Secretary of the Board, Raleigh, N. O.
Vol. XL,I FEBRUARY, 1926 No. 2
HEALTH—THE STATE'S GREATEST ASSET
MEMBERS OP THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Way, M.D., Pr('*.__Waynesville Cyeus Thompsox, M.D Jacksonville
Richard H. Lewis, M.D., LL.D.—Raleigh E. J. Tucker, D.D.S Roxboro
Thomas E. Anderson, M.D Statesville D. A. Stanton, M.D High Point
A. J. Crowell, M.D Charlotte James P. Stowe, Ph.G Charlotte
Charles O'H. Laughinghouse, M.D.,
Greenville
EXECUTIVE STAFF
G. M. Cooper, M.D., Acting Secretary.
H. A. Taylor, M.D., Director Bureau Maternity and Infancy.
C. N. SiSK, M.D., Director Bureau of County Health Work.
C. A. Shore, M.D., Director State Laboratory of Hygiene.
H. E. Miller, C.E., Chief of Bureau of Engineering and Inspection
F. M. Register, M.D., Deputy State Registrar of Vital Statistics.
M. L. TOWNSEND, M.D., Director Bureau of Health Education.
FREE HEALTH LITERATURE
The State Board of Health publishes monthly The Health Btjlletin,
which will be sent free to any citizen requesting it. The Board also has
available for distribution without charge special literature on the following
subjects. Ask for any in which you may be interested.
Adenoids and Tonsils
Cancer
Catarrah
Care of the Baby
Constipation
Colds
Clean-up Placards
Chickenpox
Diphtheria
Don't Spit Placards
Eyes
Flies
Fly Placards
German Measles
Hookworm Disease
Infantile Paralysis
Indigestion
Influenza
Malaria
Measles
Pellagra
Public Health Laws
Prenatal Care
Sanitary Privies
Scarlet Fever
Smallpox
Teeth
Tuberculosis
Tuberculosis Placards
Typhoid Fever
Typhoid Placards
Venereal Diseases
Water Supplies
Whooping Cough
FOR EXPECTANT MOTHERS
The Bureau of Maternity and Infancy has prepared a series of monthly
letters of advice for expectant mothers. These letters have been approved
by the medical profession. They explain simply the care that should be
taken during pregnancy and confinement, and have proved most helpful
to a large number of women. If you want them for yourself or a friend,
send name to the State Board of Health, and give approximate date of
expected confinement.
CONTENTS
North Carolina Oysters 3
Five Thousand Deaths Without Medical Care 9
Fifteen Cases of Typhoid in One Faiiiily 13
Another County Sanatorium 13
Value of Milk and the Cost of Bottled Milk 14
lnl®ali
Vol. XLI FEBRUARY, 1926 No. 2
NORTH CAROLINA OYSTERS
A dainty morsel that will tickle ttie
palate of the most fastidious epi-curean
!
What?
No oysters of the Atlantic coast are
more luscious and none are more abso-lutely
free from any possibility of con-tamination
than are those taken from
North Carolina waters.
Throughout the entire length of the
North Carolina coast line there extends
a sand bank upon which the tides and
storms of the mighty Atlantic beat. Be-hind
this bank of sand (which varies
in width from a few yards to three
miles) there are sounds and bays, with
relatively very shallow and quiet
water. Back of this shallow water, on
the mainland, are many miles of low-land
and marsh, upon which there are
no large cities and where the poptila-tion
is sparse. These thousands of
square miles of shallow water, fed
daily through the inlets, by the tides,
with fresh sea water, and isolated from
human habitation, furnish an almost
unlimited area for ideal oyster beds.
These beds, protected from the ele-ments
by a natural barrier, and pro-tected
from pollution by a wide area
of sparsely settled country, are capable
of producing, and do produce a superior
quality of shell fish perfectly safe for
human consumption.
For lack of concerted effort on the
part of the oystermen this great North
Cai-olina harvest has gone, year after
year, to the advertised markets of
other coast states.
For this reason the oyster scare of
last year, when cases of typhoid fever
were traced to raw oysters, resulted in
as great demoralization of the North
Carolina oyster industry as it did in
those regions containmg polluted beds.
There was no justification for this, for
North Carolina oysters were always
pure and wholesome. The trouble was
that they were sold under foreign
brands from doubtful markets.
The North Carolina Fisheries Com-mission
knew, and the oystermen knew,
that North Carolina oysters were safe
and that they were suffering unjustly
for the faults of others. The demoral-ized
condition of the industry last year
brought the state face to face with the
necessity of proving this fact to the
world. The experience was not only
an expensive one to the producer, but
deprived the consumer of an abundant
supply of pure and wholesome food. It
no doubt, however, was a blessing in
disguise. It taught the state to market
its own pure products under its own
state brands.
Assisted by the Governor to finance
the plans, the State Board of Health,
working in conjunction with the
Fisheries Commission and directed by
the United States Public Health Service,
equipped one of the Commission's pa-trol
boats, the "Pamlico," with labora-tory
suitable for operating over North
Carolina oyster beds, making bacterio-logical
examinations of shell fish and
run tests, and analysis of the top and
bottom waters of the sounds. To date
the reports of the results of the find-ings
of the scientists on board show
that there is not sufficient evidence of
contamination to condemn a single bed
where oysters are being taken. The
entire area has now been covered and
every North Cai-olina oyster has been
proven beyond peradventure to be safe.
With a proven safe original supply
the next move was to throw additional
safeguards around the handling of
oysters on board the boats, in the
shucking houses and canning plants. A
survey has been made of these plants,
The Health Bulletin February, 1926
MAP SHOWING DISTRIBUTION OF
SHELLFISH PRODUCTION AND
OYSTER SHUCKING HOUSES
ALONG THE COAST OF NORTH CAROLINA
LEGEND
O^stlRS . ii'IiiS^i^
CLAMS ;'wi~":i\wtSS'!iji»
OYSTERS ANo CLAMS ?!?:;Z<5SS.^f5!
CANNING PLANT ^
SHUCKING HOUSE O
A. J jL J I fC ^L 1 1 X_
Fehruary, 1926 The Health Bulletin
Ab oyster boat on its way to join the fleet.
An oyster fleet dredging oysters.
The Health Bulletin February, 1926
The "Pamlico," a former patrol boat, equipped with complete laboratory,
for the examination of shellfish, and making water analysis.
An inside view of one side of the laboratory on the "Panilico."
February, 1926 The Health Bulletin
and the operators have been found to
be very glad and anxious to provide
every suggested measure, in the way
of steam sterilizers, enamel pails, etc.,
intended for additional safety.
Having secured a standard of safety
complying with every sanitary require-ment
it was next necessary to provide
an inspection system and organization
that would guarantee the maintenance
of this condition. The laboratorv boat.
Thus, whether sold within the state
or taken without the state, every North
Carolina oyster intended for market
must pass this rigid inspection. Pure
to start with, every step from bed to
(able is carefully guarded.
Although the catch last season was
fully 33 l-39« less than normal because
of the unfavorable publicity, and did
not by any means exhaust the available
supply, there were:
A steaming plant on Core Sound. Oysters are not the only pure sea food
handled at this port, see the fish nets drjdng on the reels in the foi-egi-ound.
the "Pamlico" with its complete labora-tory
equipment and competent labora-tory
i)ersonnel, remains permanently
on the job. A corps of inspectors in
small power boats are scattered
throughout the area and every cargo
of oysters is inspected. An in.spection
fee of 11/4 cents per bushel is charged,
which sum is applied toward main-tenance
of the sy.stem. At the time
of inspection the insi>ector gives the
skipper not only his tax receipt, but
also a sanitary certificate. Before he
can sell his cargo to shuckers or cau-ners
he must produce this receipt and
certificate. Since all oyster boats leav-ing
North Carolina waters for other
markets must pass through the Dismal
Swamp canal, an insi)ector is stationed
at the locks in this canal and no cargo
of oysters can leave the state without
complying with the law.
Dredged in N. C. waters 301,095 bu.
Exported in the shell.... 30,245 bu.
Steamed within the
state, but exported to
to be sold under for-eign
label 211,047 bu.
Shucked within the
state and exported
fresh to be sold under
foreign label 58,303 bu.
Sold in shell within the
state 1,500 bu.
This brings us to the most lamentable
phase of the oyster situation.
Although North Carolina oysters are
the best and purest on the market, the
consumer has not been so advised.
The above figures furnished by the
Fisheries Commissioner for last season
show that practically the entire North
Carolina oyster crop was disposed of
8 The Health Bulletin February, 1926
incognito. Thirty thousand bushels
were taken in the shell outside the
state to be shucked and sold under a
foreign label. About 270,000 bushels
(one bushel or tub of best grade oysters
will shuck about one gallon) were
steamed or shucked within the state
but taken out of the state without label
to be marketed under a foreign label.
Many of these were shipi>ed back into
the state for consumption. The con-sumer
really ate North Carolina
oysters but thought he was getting an
out-of-the-state product.
With all this round about handling
there is not only much delay in reach-ing
the dealer, but the dealer pays an
average of $1.00 per gallon more for
North Carolina oysters which he buys
from a Norfolk or Baltimore shipper
than he would pay for the same oysters
bought from a North Carolina shipper.
The dealer can scarcely be blamed
for this for he must supply what his
customers call for—they are the ones
who pay the bill. The customer has
eaten "Norfolk" and "Baltimore"
oysters so long (without knowing that
in many instances they came from
North Carolina waters) that he thinks
he must have "Norfolk"' or "Baltimore"
oysters.
When consumers leaim the facts and
call for "North Carolina oy.sters" the
dealers will be glad to supply them.
The appended list shows the name,
address and permit number of 74 North
Carolina packers and shippers. Ship-ping
tins are now labeled "N. C. Permit
No "
When your dealer shows you a can
with this label stamped in the tin or
painted thereon you may be sure that
the oysters it contained when it left
the hands of the packer were safe for
food.
LIST OF OYSTER SHUCKERS AND PACKERS IN NORTH CAROLINA
Name Addrex
Permit
Number
Woodland & Company
Southgate Packing Co
Washington Fish Co
George N. Ives
G. W. Bowden.
Lupton Fish and Oyster Co
Reuben Williams -.
George Baker
George Moore
P. Speight .
E. S. Lupton ,/.
S. F. McCotter
Charles H. Squires _
J. W. Rollins...
S. E. Styron
Almon Hamilton
Wilbert Lewis
C. W. Greene ^-.
Ford Seafood Company _.
Manning Brothers
Amos H. Dudley
A. M. Boyd
U. S. Boyd
Swmdell-Fulford Co
Norfolk-Southern Meat Market
H. J. Shaw
A. Marbley
George Dudley .-
John Henry Becton
Elihu Boyd
Stephen Davis
Amos Dudley
Walter Bell
Pamlico Fish Company..
Morehead City.
Beaufort
Washington
New Bern
New Bern
New Bern
Belhaven
Belhaven
Washington
New Bern
New Bern
Vandemere
New Bern
Manteo
Davis
New Bern
Stacy
New Bern
Manteo
New Bern
Morehead City
Morehead City
Morehead City
Washington
New Bern
New Bern
Morehead City
Morehead City
Morehead City
Morehead City
Marshallberg...
Morehead City
Morehead City
Washington
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
February, 1926 The Health Bulletin
LiIST OF OYSTER SHUCKERS AND PACKERS—Continued
Permit
Number
Eastern Fish Company
Henrietta Carter..
George R. Russell
Henry Bryant
James T. Salter
Willis Seafood Co
John Monroe
Jim Tillery
W. P.Boyd
Finer Brothers
Adams & Company
Tom T. Lassiter
C. H. Harris
Tolson-Sniith
Charles V. Webb
Duffy Wade
Haywood Bell
Mott Hester
Emma Dudley
A. W. Walston
Bert Tillery
Delia Jones
V. Taylor Packing Co.
.
Ernest Mattocks
W. H. Varnum
George Gorham
R. T. Alford
J. F. Morris & Son
Frank Ewing
T. J. Franks
C. L. Bowden
Lender Swindell
W. 1. Wilson
J. O. Bowden
Jim Pigott
X. M. Pigott
A. H. Parker
J. E. Hines
J. L. Phillips
E. .M. Chadwick
Washington
Morehead City
Beaufort, R. F. D
Morehead City
Davis
Beaufort
Morehead City
Morehead City
Morehead City
Morehead City
Morehead City
New Bern
New Bern
Morehead City
Morehead City
Morehead City
Morehead City
Morehead City
Morehead City
New Bern...
Morehead City
Morehead City
Sealevel
Morehead City
Supply
Washington
Seagate
New Bern
Wilmington..
Seagate
Wilmington
James City
Wilmington
Wilmington
Morehead City
Shallotte
Shallotte
Seagate _..
Washington
Gloucester
C. 35
C. 36
C. 37
C. 38
C. 39
C. 40
C. 41
C. 42
C. 43
C. 44
C. 45
C. 46
C. 47
C. 48
C. 49
C. 50
C. 51
C. 52
C. 53
C. 54
C. 55
C. 56
C. 57
C. 58
C. 59
C. 67
C. 68
C. 69
C. 70
C. 71
C. 72
C. 73
C. 74
FIVE THOUSAND DEATHS WITHOUT MEDICAL CARE
I
During the year 1924 there were in
North Carolina 5,515 persons who died
without medical care. That is, there
were this number whose death certifi-cate
show no doctor attended them. In
addition to this number tliere were
many more for whom the doctor was
called only at the last moment. In
this case he signed the certificate but
actually had not attended the patient
during the illness.
Many of these deaths could have been
prevented by the aid of a physician.
And this is the lamentable thing. What
does it avail for medical science to be
efficient in the curing of disease if
medical science has no opportunity to
exercise its skill?
We cannot believe it was physically
impossible for some physician to have
reached practically every one of these
imattended deaths. As a class, no pro-fession
is more liberal with its services,
therefore it is hardly probable that any
one of these unattended deaths could
not have gotten a physician had an ef-fort
been made to do so, however poor
the patient may have been.
Furthermore, society is generally
awake to the needs of its fellows and
10 The Health Bulletin February, 1926
provision is quite frequently made to
care for ttiose, at public expense, wlio
are themselves unable to bear the ex-pense.
The only actual reason then for
these unattended deaths is a matter of
ignorance—or carelessness. Ignorance
on the part of the family—or careless-ness
on the part of society.
Public sentiment througliout the state
should be aroused to the degree that
those responsible should be held in dis-gi'ace
if they allow any person in the
state to die without every effort being
made to secure adequate medical care.
Privilege brings responsibility and
every person who is granted the privi-lege
of wielding an influence in his
community is held morally responsible
for that influence. These are the per-sons—
these intelligent persons with in-fluence—
who are responsible for these
five or six thousand unattended deaths
each year in North Carolina. "Am I
my brother's keeper?" is a question that
must have an individual—a personal-answer.
But privilege is never given
except with commensurate responsi-bility.
An incident comes to mind, of which
the fact of every detail can be vouched
for, which illustrates an almost uni-versal
situation. The mother of nine
children was taken seriously and
mortally ill. The father was an honest,
hi.rd-working man whose every efCort
and every penny of earning was de-voted
to his family. They lived in a
rather densely populated and wealthy
county. The sick mother was taken to
a hospital where she remained until
it seemed impossible for the father to
raise more money to pay hospital bills.
The phjsicians attending her were the
best in the country but her malady
could not be cured and she was taken
home. One of the physicians who had
seen her in the hospital, along with the
other physicians, undertook to attend
her at home, although he knew he could
not in any possible way expect any
pay, and knew that her illness would
be prolonged. None of the surgeons
who had attended her in the hospital
had received any pay and did not ex-pect
any. This physician visited her
in the home 83 times. He took with
him in consultation, at different times,
six different physicians. He did, at the
house, three minor operations which
required the assistance of his ofiice
nurse. The minimum total foes this
doctor should have received for his
services to that home would have been
at least $300, yet he did the work as
willingly and as efiiciently without re-ceiving
one penny as if he had known
the money was forthcoming. This case
is no exception. Doctors are doing the
same thing everywhere.
In this case the responsibility was no
more on this doctor as a citizen of his
community than it was on every other
citizen. The doctor pays his city, coun-ty,
state and federal taxes, and is
charged by his state a special tax of
$25 per year for the "privilege"' of
practicing medicine. The burden is a
community burden and in this one case
this doctor paid, in services and ex-pense,
the equivalent of $300 tax, over
and above all the other taxes which the
butcher and baker and candlestick-maker
had to pay. And he paid a
special tax of $25 per year for the
privilege of doing it.
Today the doctor called ten miles in
the country to see a deserving, but
poor patient, will usually go, (doctors
are human and there are some who
would not go) but first he must drive
by the filling station to get gas for his
automobile. This he pays for in cash.
Then he remembers that his medicine
case needs filling, (for this is ten miles
in the country) so he drives by the
drug store, and some way even drug
supply houses have a habit of insist-ing
that drugs be paid for. Finally
after taking two or three dollars in
cash out of his pocket he goes to his
patient. He returns with a clear con-science
but wonders where he will get
the price of a beefsteak and a loaf of
bread to carry home for his supper.
There were very few of these five or
six thousand persons who died uilat-tended
in this state in one year who
could not have got medical aid in some
manner. There is no spot in the state
where you, who read this, could not
have very soon got medical aid had
your child, your wife or husband, or
your parent been sick unto death.
"Where there is a will there is a way"
and YOU would have found a way.
The responsibility is yours and mine
to see that unattended deaths do not
occur. As the matter now stands, the
charity of the medical profession.
February, 1926 The Health Bulletin 11
(freely offered to the needy individual,
but NOT to the well-to-do city, county
or state) may have to be accepted. As
soon as arrangements can be made, the
burden should be distributed to the
shoulders of those whose duty it is to
bear it. The county hospital is one
plan advocated by many, and is a plan
which deserves the most serious con-sideration.
The following table is appended
purely as a statement of facts. There
is no intent to make comparisons and
no need of further comment.
Table showing the total number of deaths during 1924 by race and by
counties. ALso showing the number of deaths

UN C CH HEALTH SCIENCES LIBRARY
H00352060G
i'
^bt Libtarp
of t^t
^nitjersitp of H^ortb Carolina
CnliotoeD b? ^^e SDiaUctic
ano
PSilantSropic &ocietie0
rsi86W
v.5B-4»
McJ. I.b.
This hooh must not
be taken from the
Library building.
5^
LUNC-15M N.36
OP-13370
DIVISION OF DOCUMENTSt
WASHIfJGTON, D. C.
PuTDlislyedbH inL. N°KJI\QP^UMIK STATE. DPARDs^AE^LTA
1 Th)5 Bu]1elir\willbe 5er\t free to arwj citizen of Ihe 5tcrte upoi\ request j
Entered as second-class matter at postogice at Raleigh, N. C, under Act of July 16, 1894,
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. XLI JANUARY, 1926 No. 1
HEALTH—THE STATE'S GREATEST ASSET
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Wat, M.D., Pres Waynesville Cyrus Thompson, M.D Jacksonville
Richard H. Lewis, M.D., LL.D. Raleigh E. J. Tucker, D.D.S Roxboro
Thomas E. Anderson, M.D Statesville D. A. Stanton, M.D High Point
A. J. Crowell, M.D Charlotte James P. Stowe, Ph.G Charlotte
Charles O'H. Laughinghouse, M.D.,
Greenville
EXECUTIVE STAFF
G. M. Cooper, M.D., Assistant Secretary.
H. A. Taylor, M.D., Deputy State Health Officer.
C. A. Shore, M.D., Director State Laboratory of Hygiene.
H. E. Miller, C.E., Chief of Bureau of Engineering and Inspection
F. M. Reglster, M.D., Deputy State Registrar of Vital Statistics.
M. L. Townsend, M.D., Director Bureau of Health Education.
FREE HEALTH LITERATURE
The State Board of Health publishes monthly The Health Bulletin,
which will be sent free to any citizen requesting it. The Board also has
available for distribution without charge special literature on the following
subjects. Ask for any in which you may be interested.
Adenoids and Tonsils
Cancer
Catarrah
Care of the Baby
Constipation
Colds
Clean-up Placards
Chickenpox
Diiihtheria
Don't Spit Placards
E.\es
Flies
Fly Placards
German Measles
Hookworm Dif-ease
Infantile Paralysis
Indigestion
Influenza
Malaria
Measles
Pellagra
Public Health Laws
Prenatal Care
Sanitary Privies
Scarlet Fever
Smallpox
Teeth
Tuberculosis
Tuberculosis Placards
Typhoid Fever
Typhoid Placards
Venereal Diseases
Water Sup])lies
Whooping Cough
FOR EXPECTANT MOTHERS
The Bureau of Maternity and Infancy has prepared a series of monthly
letters of advice for expectant mothers. These letters have been approved
by the medical profession. They explain simply the care that should be
taken during pregnancy and confinement, and have proved most helpful
to a large number of \yomen. If you want them for yourself or a friend,
send name to the State Board of Health, and give approximate date of
expected confinement.
CONTENTS
Pneumonia 3
Biliousness 3
"I Never Thought of That" 5
Winning the Typhoid Fight 7
Condensed and Evapora ed Milk -Tr^ll
The Advancing Knowledge ol" Cancer-- 14 ^e¥ Hr^len
Public Health Nursing-
Look to Wholesome Home Environment 24
Children Spoiled by too Much Love 25
Importance of Being a Parent 26
No Ventilation—Six Lives Lost 26
"Care^mw-'Iloothbrush 27
27
;he Bath 30
RECEtVCO
19 The Story of
JAN 1 f) 1926
nor~l IftiiPibi-re r\*\, ttLit-\%A
I PU5LI5ALD BY TML nQR.TA CAgOLIhA 5TATE. BOAfgP g^MLALTM I
Vol. Xlil JANUARY, 1926 No. 1
PNEUMONIA
We are just now reaching the season
when pneumonia is beginning to talce
its most territic toll of human life.
During January, February and March
more people die from this disease than
during the remaining nine months of
the year. During these three months
of 192.5 pneumonia killed, in North
Carolina, at the rate of over five hun-dred
per month.
If you live in a village of five hun-dred
people, think of an entire village
tlie size of yours, men, women and chil-dren,
being completely wiped off the
map in this State each month during
January, February and March. Re-member
that is just what this one
dibcase, pneumonia, is doing. The total
is approximately 3,000 deaths per year.
Pneumonia can much more easily be
prevented than cured and prevention is
a personal matter depending on each
individual. The doctor will do all he
possibly can to relieve a patient that is
sick, but preventing the disease is a
matter entirely in the hands of the in-dividual.
The doctor cannot do that
for him any more than he could eat
his food for him or sleep for him.
In one series of 1408 pneumonia pa-tients,
taking them as they came 852
gave a history of having been ill with
a common cold for several days previ-ous
to the development of pneumonia.
Some important measures in prevent-ing
pneumonia which every one should
know are
:
1. Consider seriously and treat ade-quately
all "common colds."
2. Dress to suit the weather, remem-bering
that clothing is for protection,
rather than alone for adornment.
3. Avoid sudden chilling, wet feet and
wet clothing.
4. Vitality, or resistance to infection,
is greatly lowered by lack of exercise,
excessive fatigue, loss of sleep, excesses
of any kind, and poor food.
During dangerous seasons be especial-ly
careful to maintain vitality at its
very highest.
5. Avoid all unnecessary contact with
persons sick with pneumonia, flu or
colds. They are contagious.
6. Keep hands clean.
7. Do not let fingers or anything else
except proper food and drink enter the
mouth or touch the lips.
8. Avoid overheating of living rooms
and be assured that there is ample
ventilation to keep the air fresh.
BILIOUSNESS
The term "biliousness" may not be a
strictly scientific word but hearing it
calls to the mind of every man, woman
and older child in North Carolina a
certain definite and unhappy picture.
By whatever name it may be called
there is lack of appetite, a sense of
malaise, indisposition to either mental
or physical activity, drowsiness, often
giddiness, a bad taste in the mouth
and a bad breath, the tongue is cov-ered
with a rather thick slimy coating,
there is inactivity of the bowels and a
peculiar "bilious" color in the skin,
dark circles under the eyes and usually
there is a severe and distressing head-ache.
Sooner or later there will be
nausea and vomiting. The vomited
matter is a liquid, yellow, or greenish
yellow in color and as "bitter as gall."
This condition has been seen by every
one and experienced by most persons.
The Health Bulletin January, 1920
A condition of this sort confronts the
"family doctor" more often, perhaps,
than all others combined.
Gallstones forming in the gall blad-der
sometimes stop up the gall ducts
and prevent the flow of bile into the in-testines.
This dammed up bile is then
reabsorbed into the blood and carried
throughout the system and deposited
in every tissue of the body. .This de-posited
bile pigment is what gives to
the skin and the whites of the eyes
that "yellow as a pumpkin" jaundiced
color.
In at least a great many cases of so-called
"biliousness" there is a slightly
analagous condition caused by a con-centration
of the bile. This interferes
with its normal flow and results in its
reabsorption into the blood, to be partly
deposited in the tissues and partly to
be re-eliminated by the liver. With each
cycle, of course, it becomes more and
more concentrated. In biliousness the
bile is not dammed up as in gall-stones
but because of the impeded
flow of the thickened bile there is re-absorption
into the blood and a deposit
of bile pigment into the tissues.
Because of the inactivity of the
bowels in this condition there is neces-sarily
a reabsorption also of the poisons
from uneliminated waste in the intes-tines
and this poison or toxin together
with the reabsorbed bile gives rise to
many of the symptoms noticed.
Inseparably linked with the word
biliousness is that other word, calomel.
Calomel has a double action. It is a
purgative and also a cholagogue (bile
driver), hence calomel in "biliousness"
empties the intestinal tract and also
liquefies the bile and stimulates the
liver cells to excrete more bile. Thus
with the intestines emptied the bile
ducts and gall bladder emptied and the
liver cells filtering out of the blood the
accumulated bile the condition speedily
clears up.
Calomel, however, has its disadvant-ages.
It is of itself a very poor pur-gative
and should never be taken, ex-cept
upon the specific advice of a phy-sician.
When taken into the stomach
and absorbed into the blood it is an
excellent stimulant to liver activity. Its
absorption is rather slow, hence should
be taken in the minimum needed doses
to accomplish this purpose and given
time to be absorbed before a purgative
is taken to empty the bowels.
Epsom salts and castor oil are ex-cellent
purgatives. They do quickly
and thoroughly empty the intestinal
tract but they have no stimulating ac-tion
on the liver and do not liquefy the
bile. These drugs by themselves will
not clear up the symptoms of the con-dition
popularly known as biliousness.
If, however, the bowel contents are
never allowed to stagnate, then bilious-ness
is much less likely to occur, and
such drugs are much more valuable in
preventing biliousness than in curing
it. In recent years a mechanical method
has been devised of draining the gall
bladder without the use of purgation.
It consists in the passage of a small
tube by swallowing it very like a
stomach tube through the stomach and
into the duodenum (the upper small in-testine).
The procedure is simple and
usually gives the patient little incon-venience
but does require some time. In
cases where indicated it often gives
most happy results.
"Biliousness" may not be the proper
name for it but the condition described
is very real and very common. It is
relieved by anything that empties the
bowels to stop further toxemia and by
emptying the gall bladder and clearing
from the body tissues the accumulated
bile and waste iwisons.
The health oflicer who operates in a
community where a substantial propor-tion
of the citizens have received basic
instruction in preventing disease and
in the general activities of the health
department is able to accomplish re-sults
in the saving of lives of which
we have scarcely dreamed in the phil-osophy
of the past.
—
Dr. Ray Lyman
Wilbur.
Education is the basis on which any
dental health program should be de-veloped.
It should begin in the pre-natal
clinics and should extend through
the school life of the child. Filling a
cavity is palliative treatment unless !
one understands and practices the
|
fundamentals of preventive dentistry. | —William A. Griffin, D. D. S.
January, 1926 The Health Bulletin
''I NEVER THOUGHT OF THAT"
One Reason Why Over Ten Thousand People Die Each Year in the
State From Deg-enerative Diseases is Just Plain Carelessness
"Hello, Sam, what's wrong with you?
Been in a wreck?"
That was the greeting of a fi-iend as
Sam Jones limped painfully along to-wards
his office on a snappy December
morning.
"No, nothing like that, Bob," Sam
replied. "Fact is, it's nothing but a
touch of rheumatism. Sure is talking
to me this morning, though. Been
troubling me a little in that left knee
for some little time. Now it's moved
on up into the hip, and it's just about
all I can do to travel this morning."
"What are you walking for? Where's
the car?" Bob wanted to know.
"It's over at the shop. I'm having it
wne over thoroughly, like I do every
three months. Say, Bob, that's the best
investment I ever made. You know,
I've had that car something over three
years now, drive it pretty constantly,
and repairs on it haven't amounted to
hardly anything. Every three months
I set it in the shop for an inspection,
and they fix up what little minor
trouble there may be, and it runs just
as sweet now as it did when I got it.
It's mighty good practice, and cheap
insurance, I tell you."
"How long since you have had a doc-tor
look you over?" Bob inquired.
"Let's see now, I don't believe I've
had a doctor since I had the flu back
in 1918. There's been nothing wrong
with me except this rheumatism here
lately."
"Well, then, do you think more of
your car than you do of yourself?" Bob
wanted to know. "Or do you think at
all? Here you have your car carefully
looked over every three months to keep
it from going bad, and you let your-self
go for seven years. Why don't you
apply the same reasoning to yourself
as you do to your car? If you had you
probably wouldn't be so crippled up
with rheumatism that you can hardly
walk down town. Besides, that rheuma-tism
is only a symptom of something
wrong inside. Better go right on over
and have a careful examination made."
"Bob, I reckon I'm just a plain fool,
I never thought of that. I'm on my
way right now."
There are thousands in North Caro-lina
just like Sam Jones. They go on
day after day, and the days run into
weeks, and months, and years, and they
never think of giving their bodies a
square deal. Their automobiles cost
money, and so they spend money keep-ing
them in good order, and spend
money in preventing trouble from de-veloping.
But only when sick, and too
sick to work, do they seek relief. Then
they want a quick job from the doctor,
one that will put them back on their
feet in a hurry, regardless of what may
be the hidden trouble.
At the beginning of another year, it
is timely to suggest that a physical ac-counting
be made. What are your
health assets and liabilities, and how
do your body accounts balance? You
would not think of running your busi-ness
without keeping some accounts,
and the annual inventory is routine.
Why run your body without getting at
least a yearly balance to show if there
are any losses or gains?
It is a well-known fact that thou-sands
of lives in infancy and childhood
Lave been saved in the past few years
by the spread of knowledge concerning
the care of babies and child hygiene,
and the medical inspection of school
children. Not only have thousands of
lives been saved, but these school chil-dren
have been made healthier and
more efficient in their school work.
But while the death rate among chil-dren
has been coming down rapidly, the
death rate for adults has been climb-ing.
We are saving infant life and
wasting adult life. The "old age"
diseases are creeping into middle life
and carrying off men and women at the
time when their lives are most useful,
and when they should be enjoying life
6 The Health Bulletin January, 1926
to the fullest. At least a half million
American citizens die annually from
preventable or postponable diseases of
the heart, arteries, kidneys and cancer.
Here in North Carolina last year
there occurred 11,964 deaths from a
group of five preventable or curable
diseases to vrhich persons of middle life
It is estimated that 75 of each 100
deaths between the ages of 20 and 65
are caused by one of these diseases.
The majority of the more than eleven
thousand occurring from these causes
were premature. They should have been
prevented, cured, or postponed to be-yond
seventy years of age.
THOROUGH CHEST EXAMINATION
Important part of physical examination to detect incipient tuberculosis.
are especially susceptible. The figures Wonderful progress has been made
are as follows
:
in North Carolina in improving the
Nephritis 1,804 health of children; in the control of
Heart Disease 3,661 the communicable diseases; in better-
Apoplexy and arterio-scle- ing sanitary conditions throughout the
rosis 2,509 State. There is much yet to be done.
Cancer 1,289 however, and an imrwrtant next step
Tuberculosis 2,701 must be towards the raising of the phy-
• sical standard. By learning the lesson
Total 11,964 of prevention we can get at these de-
January, 1926 The Health Bulletin
generative diseases in time to stop or
cure them. Through a periodic physical
examination, at least once a year, bodily
defects and the early signs of the
"breaking down" diseases of the heart,
arteries and kidneys can be detected
and the necessary remedy applied.
The cost is negligible. Thirty minutes
to an hour of your time, and a modest
fee to the physician is all. The gain
to you may be ten or twenty years of
added life. It may be that you have
no symptoms so far as you know, and
don't feel sick, and yet a thorough
physical inspection may reveal the first
indications of a serious disease at the
time when it may be headed off or
cured. The 1,289 who died of cancer
last year did not know they were sick
until it was too late. Yet every one
of them could have been saved had
their trouble been discovered in time.
Give j-ourself a square deal. Treat
your body with as much care as you
give to your car. Start the New Year
with a physical inventory.
/ WINNING THE TYPHOID FIGHT
How North Carolina Has Succeeded in Makings Typhoid Fever
Comparatively Unknown in the State
In the past eleven years the death
rate from typhoid fever in North Caro-lina
has been reduced by 72 per cent.
From its position near the top in the
United States the State has been pulled
down to a place among those states
having the least typhoid fever, and now
heads the list of the Southern States
with the lowest death rate fi-om this
particular disease.
To those whose memory goes back to
the early days of the present century
when typhoid fever was accepted as a
natural accompaniment of the summer
months, the question naturally arises,
how has this disease been so nearly
conquered? A prominent newspaper
editor of the State last summer re-marked
that he could remember when
every week his paper carried the report
of five or six or more deaths from ty-phoid,
and now even a case in the
county was unusual.
The intensive fight against typhoid
fever began in 1914, when definite plans
were adopted to be carried into effect
the following year. Vaccine for the
prevention of typhoid fever had been
thoroughly tested and its efficacy estab-lished.
So the State Board of Health
decided to attempt mass immunization
on a large scale.
Under the guidance of Doctor G. M.
Cooper, then serving as director of
rural sanitation for the Board, con-tracts
were made with seventeen coun-ties
under the terms of which the coun-ty
authorities appropriated sums suf-ficient
to pay the expenses of the field
agents of the Board. Dispensary points
in each county were selected that would
be as convenient as possible for the
people of each section to reach. An ad-vertising
campaign designed to give full
information with regard to the preva-lence
of the disease, its dangers, and
the means of prevention was inaugu-rated.
In June the actual work was
begun.
In these counties a total of 52,000
complete inoculations were given that
summer. That is, that many persons
received three administrations of ty-phoid
fever vaccine, the doses being
given at intervals of one week. The
response on the part of the people was
enthusiastic. The results were much
greater than had been anticipated, and
this first year's campaign was consid-ered
an unqualified success.
For the first time in th-^ United States
the effort had been made to reach a
large mass of civilian population with
preventive typhoid treatment. It was
demonstrated that such a campaign
could be successfully consummated.
Due credit should be accorded the coun-ty
authorities who made this preventive
work possible, and to the citizens of
those counties who so whole-heartedly
responded. The seventeen counties were
Alamance, Buncombe, Cabarrus, Cald-well,
Craven, Cumberland, Durham,
Edgecombe, Guilford, Henderson, New
The Health Bulletin January, 1926
TABLE 1
Check mark indicates counties in wliich typhoid vaccination campaigns
were conducted by State Board of Health, or local county health department,
1915-1925.
Total complete vaccinations, 807,978.
County
January, 1926 The Health Bulletin
TABLE 2
Twelve counties in which no typhoid vaccination campaigns was con-ducted,
1915-1925, showing death rate from typhoid fever by years for
seven years, 1918-1924, inclusive.
Cot7NTr 1£18
10 The Health Bulletin January, 1926
vear, the record complete being as fol-lows
: 1915, 17; 1916, 15; 1917. 10;
1918, 14; 1919, 35; 1920, 32; 1921, 57;
1922, 53; 1923, 44; 1924, 48; 1925, 52.
The frequency with which immuniza-tion
campaigns have been conducted in
individual counties is shown in the ac-companying
table. It will be noted that
in twelve of the counties there have
been no campaigns throughout the pe-riod,
while in some others there has
been one each year continuously since
the beginning of the work. Altogether
for the eleven year period the State
Board of Health has records showing
807,978 complete vaccinations. This in-cludes,
of course, those persons who
have followed the safe course and been
re-vaccinated at intervals of three
years. It does not include a large num-ber
of inoculations given by physicians
in the routine course of their practice.
the number of which it is not possible
to accurately estimate.
Now all this was costly. It cost in
time and energy and money. Did it
justify itself in direct, tangible results?
The answer is shown by the figures that
follow.
In 1914 the total deaths from typhoid
in the State numbered 839, giving a
death rate of 35.8 per 100,000 of popu-lation.
In 1924 the deaths from typhoid
in the State numbered 270, giving a
death rate of 9.9 per 100,000 of popu-lation.
The reduction in the death rate
was 72 per cent. Or to put it another
way, if no efforts had been made to
eradicate typhoid fever, and the same
death rate had prevailed in 1924 as in
1914, 967 citizens would have succumbed
to the disease. For the year, as com-pared
with eleven years previously,
there was a saving of 697 lives, and ten
times the saving in serious illness. The
accumulated saving of lives year by
year for the eleven years would total
the population of a small- city.
It has been noted that twelve coun-ties
in the State have had no intensive
anti-typhoid work. They are Ashe,
Cherokee, Dare, Graham, Haywood,
Jones, Macon, Madison, Pender, Polk,
Transylvania and Tyrrell. These are
nearly all located either in the moun-tains
or on the coast, are small, and
sparsely populated. The total popula-tion
for the twelve Is only 155,521. No
one of them contains any considerable
groups of urban population. In such
counties typhoid fever and other com-municable
diseases would be expected
only as sporadic cases, the opiwrtuni-ties
for spread being extremely re-stricted.
Against this group of twelve counties
which have made no effort to eradicate
typhoid fever may be compared a group
of twelve others in which anti-typhoid
efforts have been most continuous and
intensive. These counties are Cabarrus,
Cumberland, Durham, Guilford. New
Hanover, Northampton, Pitt, Robeson.
Rowan, Sampson, Wake and Wilson.
Almost without exception the.se coun-ties
are large and thickly populated.
They contain many large groups of
urban population, and present excellent
opportunities for the quick spread of
typhoid fever and other communicable
diseases. The total population of these
twelve is 589,358.
Detailed statistics year by year for
1918-1924 inclusive are given for the
two groups in an accompanying table.
For convenience the first twelve, or
those having had no anti-typhoid work,
are called Group A. and the second
twelve, or those having had the most
intensive anti-typhoid work. Group B.
The following is a comparative show-ing
of the typhoid death rates in the
two groups, the avei'ages for the seven
years.
1918 1924 Reduction
Group A .... 13.8 9.9 28%
Group B .... 26.5 8.8 67%
State 22.2 9.9 55%
While the death rate dropped in the
Group A counties from 13.8 to 9.9, a
difference of 3.9, in the Group B coun-ties
it dropped from 26.5 to 8.8., a dif-ference
of 17.7. The comparison of the
rates of reduction shows 39% greater
reduction for the group of counties
doing intensive work, and this in spite
of their natural handicaps. From the
showing made, it can be said that had
the Group A counties made the same
etScient efforts to eliminate typhoid as
were made by Group B counties, then
those counties now would be practically
free from the disease.
Expressing it in terms of total deaths
rather than rates, in 1918 Group A
counties had 29 deaths from typhoid
and in 1924 they had 22, a difference
January, 1926 The Health Bulletin 11
of only seven. Group B counties in
1918 had 128 deaths from typhoid and
in 1924 had 56, a difference of 72. Had
the same intensive anti-typhoid meas-ures
been applied in Group A counties
as were utilized by Group B counties,
the results should have been certainly
as successful, and probably more so be-cause
of natural advantages in these
counties. The same degree of reduction
in typhoid would have meant a saving
of 20 lives in these counties for 1924
as compared with 1918, instead of
seven, and the sickness and loss sus-tained
by having had about 150 pre-ventable
cases of the disease. Consider-ing
the nominal cost of securing ty-phoid
vaccinations, it would appear
that these counties practiced a false
economy.
Of course, other factors have con-tributed
to the decline, in addition to
the vaccinations that have been secured.
Foremost among these other factors
is the immensely improved sanitary
conditions that have resulted from the
enforcement of the sanitary privy law,
enacted in 1919. The number of pro-tected
public water supplies, and sew-erage
systems, has been growing, and
the total number of people so served
more than doubled in the past ten years.
Dependable milk control measures
have been instituted by a number of
communities. The general educational
work of the Board has been amplified
in character and has been constantly
reaching an increasing number of peo-ple
each year. But these additional
factors affecting the typhoid death rate
have been general, on a State-wide
basis, so that the effect has been fairly
evenly distributed over all counties. It
would appear conclusive, therefore, that
the determining factor in the reduction
of the typhoid death rate in those coun-ties
where it has been greatest has
been the fact that a large portion of
the population of those counties have
been periodically vaccinated.
Let us consider for a moment what
a skillful owner of horses does for
a very fine colt, the progeny of ex-traordinary
parents—one that is worth
100 times as much as the average
horse. His first consideration is to
provide for it the right kind of food;
food which experience has shown will
be ample for the support of optimal
growth and for the maintenance of
health after growth is completed. Be-yond
this he does little in any special
way to look after its well-being other
than to provide clean, wholesome sur-roundings
and to give it an opportunity
to take exercise as it desires. It is
not put through a lot of contortions
or made to lie on its back and kick
its legs to get exercise of a suitable
nature; it walks, trots or runs, it
grows into a magnificent creature. It
rests a great deal of the time.—E. V.
McCOLLUM.
The most important of the laws of
health relates to the character and
quality of our food. Second in impor-tance
is the effectiveness with which
we rest. I would put exercise third.
—
E. V. McCOLLTTM.
CONDENSED AND EVAPORATED MILK
Frank E. Rice, A.B., Ph.D., Professor of Biological and Agricultural Chemis-try,
N. C. State College, Raleigh, N. C.
There is much confusion in most peo-ple's
minds regarding the various kinds
of canned milk found on the market.
Really there are two, and only two,
kinds of concentrated liquid milk put
up in tin cans, although there are sev-eral
manufacturers' brands. Both con-tain
considerably less water than is
found in ordinary fresh cow's milk;
both are, therefore, condensed milks.
Both are made by evaporating part of
the water from cow's milk; both are,
consequently, evaporated milks. The
main difference between them is that
the one contains a large amount of
added sugar, while the other does not.
Sweetened condensed milk, or what
is commonly called condensed milk, is
very thick or viscous, and is yellowish
ir. color; it contains 40 to 457o ordi-
12 The Health Bulletin January, 192G
nary granulated sugar. Unsweetened
condensed milk, which is ordinarily
designated as evaporated milk, is about
the consistency of light cream, and is
darker in color than condensed milk
;
it contains no added substance.
Condensed milk is kept from spoiling
by the sugar in it, just as fruit pre-serves
and molasses i-emain good almost
indefinitely. Evaiwrated milk, on the
other hand, after being sealed into the
can perfectly tight, is heated to a very
high temperature to kill the bacteria.
This process can be compared to the
ordinary method of canning fruit. It
is well known that when canned fruit
is once opened and exposed to the air
it will spoil unless kept on ice ; the
same is true of evaporated milk. But
the sweetened variety after opening
keeps just as well as before; there is
no more necessity for keeping it cold
than for keeping honey and molasses
cold in order to prevent spoilage. Of
course, if left undisturbed for weeks a
little mold may grow on the surface,
but the main body of the milk is un-harmed
and unchanged.
During the process of manufacture
of both condensed and evaporated milk,
the raw cow's milk is subjected to high
temperatures. There has always been
a diversity of opinion as to whether
heated milk is as nutritious as that
which has not been heated. The argu-ments
seem to center around these
questions: (1) Are the vitamins de-stroyed?
(2) Is the milk rendered less
digestible? (3) Are there not some
peculiar living substances in milk which
are beneficial to our health, but which
are killed on exposure to heat? With
regard to these points there should
be found some difference between
evaporated and condensed milk because
the former is heated much longer and
to a higher temperature than the latter.
Of the principal vitamins so far dis-covered,
the scurvy-preventing vitamin
is usually present in milk in relatively
small amounts and it is most easily
destroyed by heat. Evaporated milk
can be expected to contain none of the
anti-scurvy substance ; while one or two
investigators have found a little of this
vitamin in sweetened condensed milk,
it cannot be considered an important
factor.
Although a great deal depends upon
the care taken by the manufacturer in
preparing his i)roduct, both kinds of
canned milk can be expected to contain
practically as much of the other vita-mins
as raw milk.
With regard to digestibility,-—a few
investigators claim that raw milk is
better, but the large majority vote in
favor of milk that has been heated.
Raw cow's milk forms a tough clot in
the stomach, while heated milk becomes
finely divided and on this account is
more easily handled by that organ. The
protein of heated milk has been found
to be acted on more easily by the diges
five enzymes. Besides this, in the pro-cess
of manufacturing condensed and
evaporated milk the fat is rendered
very finely divided which makes it more
digestible also. All this is more im-portant
in considering the feeding of
infants and invalids than healthy
adults. To the latter, raw milk is just
as digestible as cooked milk. The im-portant
point just now is that there
is nothing peculiar about the process
of manufacturing canned milk that
renders it any less easily handled by
the digestive system than it was origi-nally.
However, there is one point of warn-ing
in this connection.—Any white sedi-ment
which is found in the bottom of
a can should be carefully stirred in
with the rest of the milk. It has been
found that the process of heating may
render some of the important mineral
salts insoluble and cause them to settle
out. Merely mixing this material with
the rest of the contents prevents any
loss.
Many people have thought that there
are some mysterious living substances
in cow's milk beneficial to digestion and
the health of man. They have thought
that by heating the milk these things
are destroyed and we are thus deprived
of their good effect. But this has
proved to be only supposition ; cow's
milk does not contain more than the
slightest trace of any digestive enzyme,
nor is there any specific substance that
can be destroyed with heat, such as an
immune body, which might assist the
bodies of children or grown-ups to re-sist
disease.
In answering the three questions
above propounded, condensed and evap-orated
milks are found to compare
January, 1926 The Health Bulletin 13
quite favorably with natural cow's milk
iu nutritive value.
The one big objection to the canned
milks, of course, is the taste. A glass
of milk made by mixing evaporated
milk and water, half and half, may
be just as nutritious as raw milk in
most resjiects, but it doesn't suit the
palate. The "cooked milk" taste may
come out sometimes in puddings and
soups. But it is not difficult to get into
the habit of using milk pi'oducts from
tins. Immediately after the Spanish-
American War the condensed milk busi-ness
grew more than at any previous
time. The soldiers had gotten used to
it, and introduced it to their families
when they got home.
There are a great many ways that
condensed and evaporated milk can be
used in food preparation wherein the
taste does not usually prove objection-able
: custards, puddings, sauces, cream
soups, ice cream, cakes, for adding to
coffee and cereals and for making
cocoa. Many people like sweetened con-densed
milk on pancakes instead of
sirup.
The next question is,—How does the
cost of canned milk compare with bot-tled
milk?
At the "Cash and Carry" stores in
Raleigh one pound tins of unsweetened
evaiwrated milk cost 11 cents and 12
cents depending on the brand ; suppose
we take ll\'-2 cents as the average. By
mixing this with an equal amount of
water two pounds of milk of average
composition is obtained. This is about
93% of a quart, which makes a quart
cost us about 12% cents. Therefore,
if we are paying more than this for
bottled milk we would be saving money
by using evaporated canned milk as
much as possible.
At the charge and delivery stores ihe
same can costs 14 or 15 cents. By using
an average of 14i/^ cents and calculat-ing
iu the same way we find that it
would cost about 15 1/^ cents to make a
quart.
Buying evaporated milk in the small
six-ounce tins is considerably more ex-pensive
as would be expected.
Sweetened condensed milk comes
mostly in 14-ounce tins ; one well known
brand is put up in 15-ounce tins and
another in 11-ounce. The label may be
expected to show the exact net contents
of the can since the laws are very
strict in this regard. The 14-ounce size
was found to cost 16 cents, the 15-ounce
20 cents, and the 11-ounce 14 cents at
most of the stores.
An inspection of these figures shows
that the 14-ounce size is by far the
most economical. It is unnecessary and
unwise to pay fancy prices for any
particular brand of canned milk just
because it is a little more widely adver-tised.
The pure food laws and sanitary
regulations nowadays are so strict that
one can depend upon it that one manu-facturer's
brand will be as good as an-other.
Sweetened condensed milk contains
289o milk solids ; ordinary cow's milk
about 12.75%. With these figures it
can be calculated that to make a quart
(2.15 pounds) of milk it will require
1% 14-ounce cans, or 18 cents worth.
However, since the product contains
about 43% sugar, worth 6V^ cents a
pound, there is present 2% cents worth
of sugar. This deducted from 18 cents
leaves 151/^ cents as the cost of making
the quart.
To sum up then,—unsweetened evap-orated
milk at 11 or 12 cents per pound
can is equivalent to natural cow's milk
at 12% cents a quart. The value of
the milk in a 14-ounce can of sweetened
condensed milk is equal to natural milk
at 15V4 cents per quart. Most bottled
milk costs well above these figures in
Raleigh, and this is perhaps true of
the whole State of North Carolina. It
is evident, therefore, that it is economi-cal
to use these canned milks in the
place of bottled milk in most cases.
As far as cash value is concerned
these are the facts. But there are some
distinct advantages of canned milk over
bottled whole milk :—It can be de-pended
on to be free from dangerous
bacteria. No matter if the cows have
tuberculosis or the milkers have scarlet
fever, the germs of these diseases can-not
survive the manufacturing process ;
so the finished product will be free
from them. There is likely to be less
waste in the use of cauntnl milk ; that
which is not used today can be used
tomorrow. Ice is not necessary before
the tin is opened, nor for the sweet-ened
variety after opening ; but un-sweetened
evaporated milk should not
14 The Health Bulletin January, 1926
be kept more than a day after opening
unless ice is used.
Of course, the big advantage that has
always been recognized is the porta-bility
of milk in tins. For camping
trips and for children on trains it is
readily carried and most useful. It
was once true that only on such special
occasions was it practicable to use milk
in tins. Now, with the price of tinned
milk low and bottled milk high, it is
economical to use these products every
day in the household, especially un-sweetened
evaporated milk.
Inasmuch as the nutritive value of
the canned milks is equal to fresh milk
in most respects, we may well urge
its use in those districts where fresh
milk cannot be obtained. It should be
possible to prevent pellagra by rounding
out the diet with canned milk as well
as with fresh milk. Of course, for this
as well as for all other maladies due to
improper nutrition fresh milk is best,
but if it is not available, by all means,
let canned milk form a part of the
diet. It is good, and the price is reason
able.
THE ADVANCING KNOWLEDGE OF CANCER
By George A. Soper, Ph.D., Managing Director The American Society for the
Control of Cancer
Some months ago the humorous re-mark
of a prominent physician to the
effect that nobody knew anything about
cancer, taken literally by a reporter
and published in evei-y newspaper in
the country, led the public to obtain an
utterly wrong idea of the state of
knowledge of this disease.
The doctor's remark produced a
hearty laugh among the many physi-cians
who heard it, for there was not
one who was not aware that the speak-er's
knowledge of the subject was ex-tensive
and detailed, nor failed to sym-pathize
with him in his exasperation
at the fact that the discovery of a
specific cure for cancer continued to
elude investigation.
It is as absurd to say that nobody
knows anything about life itself as to
say that nothing is known about can-cer.
A great many things are known
about life and about cancer, but of
course a great many things have es-caped
patient study in each case. How
much we think we know about any-thing
depends a good deal upon our
point of view. As the Chinese say, our
knowledge is like a fan which, held
close before our eyes, appears to com-prise
the universe, but to the eyes of
others usually forms but a very small
part of it.
The Existing Knowledge of Cancer
The information which exists today
in regard to cancer is not only more
extensive but of more practical value
than many persons suppose. It is suffi-cient,
if put into effect, to reduce the
present death toll by one-half among
women and one-third among men. At
least this is the opinion of Dr. Charles
P. Childe, President in 1923 of the
British Medical Association, a dis-tinguished
student of the cancer prob-lem.
If we apply this estimate to the num-ber
of deaths from cancer which occur
among men and women in the United
States, we shall find that over 40,000
people perish needlessly from this dis-ease
each year in this country. In other
words, according to Di*. Childe's opin-ion,
the lives of over 40,000 men and
women, most of them fathers and moth-ers,
many of them in the prime of
life and at the period of their greatest
usefulness, are annually sacrificed to
the failure to turn the knowledge which
exists concerning the prevention and
cure of cancer to account.
In many quarters fundamental facts
are being collected which are adding
to the sum total of information which
scientists and practicing physicians
possess as to the cause and cure of
the disease, and progress is being made
in another direction : the facts already
in existence are becoming better under-stood.
What is referred to here as the
knowledge of cancer is the composite
knowledge of those who are recognized '
Januury, 1926 The Health Bulletin 15
by the medical profession as qualified
students of that disease. As Dr. Joseph
Colt Bloodgood has said in a recent
letter to the l^ew York Times, the in-formation
on the cancer question which
is of real value is not the opinion of
one person however eminent or intelli-gent
he may be, but the consensus of
opinion of the world's authorities based
on the recorded experience of clinical
work and experimental research.
The reviewer of a book, in which the
claim was advanced that a specific had
been found that is a preventive and a
cure for cancer, said, "Cancer is such
a serious matter for the world at large
that the premature claim of having ar-rived
at a solution of this problem
and the unwarranted hope held out to
cancer sufferers by such an optimistic
statement is a matter for grave con-sideration."
Persons who would like to examine
for themselves into the amount and
character of the existing knowledge of
cancer cannot do better than to begin
with the work of Dr. Jacob Wolff, fol-low
this up with the latest edition of
"Neoplastic Diseases" by Dr. James
Ewing, Professor of Pathology at the
Cornell Medical School, and the refer-ences
to be found in the Index Medicus,
and so to the article in the latest An-nual
of the Encyclopedia Americana by
Dr. Francis Carter Wood, Director of
the Institute of Cancer Research of
Columbia University. Dr. Wolff's work,
called "Die Lehre von der Krebskrank-heit,"
is in three volumes and contains
2,626 pages; Dr. Ewing's book is 1,054
pages in length.
How the Knowledge is Increasing
It has been said that more progress
has been made toward an understand-ing
of cancer during the past fifty years
than during the preceding five hundred
years, from which it is fair to infer
that the advance which has been ac-complished
within the last fifty years
has been revolutionary.
The progress has been in more direc-tions
than can be stated within the
limits of this article. In the direction
of causation may be mentioned the dis-covery
that chronic irritation is almost
invariably one of the leading factors in
the production of cancer. As to cure,
the use of X-rays and radium has
furnished methods of treatment of in-calculable
service. Surgical procedures
have been developed to a point which
is believed to leave little more to be ac-complished
in this direction. With
reference to prevention, the whole idea
of preventing cancer by means of hy-gienic
procedures and minor surgical
and radiological treatments is not only
new but of so much value as to lead
many to think that cancer is more often
preventable than curable.
One of the results of the new knowl-edge
is that cancer can now be more
accurately diagnosed than formerly and
inestimable advantages are following
in consequence. One of these advan-tages
lies in the fact that there is today
little reason for physicians to postpone
a decision in those early cases which
come to them until a cure is no longer
possible.
Diagnoses are still difficult and not in-frequently
impossible in many early
cases, but in some of the most usual and
most curable forms and locations in
which cancer occurs they can generally
be made with certainty while there is
still time for the patient to be cured.
Cancer of the skin, for example, can
and should be diagnosed and cured in
practically every case, providing the
patient does his or her part. And so with
cancer of the lip, cancer of the breast
and cancer of the uterus. Cancer of the
buccal cavity is more readily diagnosed
than cured, although there are many
persons alive today who can testify that
cancer in this location is not hopeless,
by any means. In fact, cancer has been
successfully treated in practically every
location.
Value of Radium, X-rays and Surgery
As time passes, a better understand-ing
is being reached as to the relative
efticacj^ of radium, X-rays and surgery
and the several fields of usefulness of
these methods of treatment are being
more and more clearly defined.
The details of skillful operations are
being recorded with increasing accu-racy
and completeness, and the records
are being tabulated in larger numbers
and studied with increasing care. Mind-ful
of the fact that cancer may recur
after long intervals of time, the health
of persons who have been treated is
being watched for manv vears to see
16 The Health Bulletin January, 1926
how permanent their cures have been.
It has been possible to collect statistics
covering hundreds of cases and com-pare
the effects produced by radium
and X-rays with those obtained by
sui'gery in the treatment of cancer in
the various parts of the body where it
occurs. Thus for example there was
published in 1924 the report of a com-mittee
headed by Dr. Robert B. Green-ough,
which had been appointed by the
American College of Surgeons, in which
nearly one thousand cases of cancer of
the cervix of the uterus were brought
together witli the object of determining
the relative value of surgery, X-rays
and radium for the cure of cancer in
this particular location. In England,
the Ministry of Health has published an
analysis of 20,000 cases of cancer of the
breast, the object being to determine
by the record the efficacy of the various
methods of treatment employed.
So far as irradiation is concerned,
the net result of all the information
thus far collected is to show that, like
surgery, radium and X-rays have a dis-tinct
place in the treatment of cancer,
not only for the cure of that disease
but for the amelioration of the suffer-ing
in incurable cases. Not infrequently
surgical operations are advantageously
preceded and succeeded, one or both, by
this treatment.
Institutions Devoted to Cancel*
Research
The scientific knowledge which lies at
the basis of a true conception of the
causation, prevention and cure of can-cer
is being added to through such re-search
institutions as the Institute of
Cancer Research of Columbia Univers-ity,
the State Institute for the Study of
Malignant Disease at Buffalo, the Can-cer
Commission of Harvard University,
the Imperial Cancer Research Fund of
England, and hospital and research
organizations such as the Collis P.
Huntington Memorial Hospital, Boston;
the Memorial Hospital, the New York
Skin and Cancer Hospital, and the New
York City Cancer Institute, in New
York City ; the Barnard Free Skin and
Cancer Hospital, St. Louis; the Albert
Steiner Ward for Cancer and Allied
Diseases, Atlanta; the George Chase
Christian Hospital and Clinic, Uni-versity
of Minnesota, Minneapolis ; The
American Oncologic Hospital, Philadel-phia
; The Pennsylvania Cancer Com-mission
; The Middlesex Hospital in
England, and others.
The total number of persons who are
working constantly for the discovery of
new facts which may be usefully em-ployed
in the control of cancer is large.
Many of them are surgeons, others
radiologists, and not a few are out-and-out
research workers giving their whole
time to this work. Unlike quacks who
work secretly and do not take anyone
into their confidence, these students of
cancer are constantly discussing their
results with one another and publish-ing
their findings where all workers in
this field can see and profit by them.
Since 1907 there has been a well-established
organization of scientists
who are engaged in studying cancer,
called The American Association for
Cancer Research. The President is Dr.
Channing C. Simmons, Surgeon of the
Cancer Commission of Harvard Uni-versity,
and the Secretary is Dr. Wil-liam
H. Woglom, of the Institute of
Cancer Research, Columbia University,
New York. This Association has a
membership of 148. The papers which
are presented at the annual meeting
are eagerly awaited by students of the
cancer problem in Europe and America.
They are published in the Journal of
Cancer Research.
What Everyone Should Know
Twelve years ago, our Society was
established to carry on a campaign of
education as a means of turning the
existing knowledge of cancer to the full-est
account. The founders knew that it
would not be necessary to wait until a
complete cure for cancer had been dis-covered
before systematic help could be
given to the 250,000 or more sufferers
from this disease who existed in the
United States and Canada.
The hopes of the organizers have
been fully justified. During the dozen
years of its existence, the American
Society for the Control of Cancer, has
given instruction by means of lectures,
new.spaper articles, radio talks and
other vehicles of publicity in all parts
of the United States and in many of
the Provinces of Canada, and it is esti-mated
that not less than 50,000,000
people have thus obtained their first
January, 1926 The Health Bulletin 17
lesson in regard to this disease. It will,
of course, be necessary to follow this up
with further Instruction. The public
has received some knowledge of the
early symptoms of cancer and has been
told to go immediately to a competent
physician upon the first appearance of
the disease. About 25.0(X) volunteer
workers are engaged in this educational
work in the course of the year. The
Society maintains national headquar-ters
at 370 Seventh Avenue, New York
City, where it is glad to answer in-quiries
on any and all aspects of the
cancer problem.
How Cancers Start
The new knowledge teaches that can-cers
always start in a small way. At
first they are miniature cancers. They
grow slowly and insidiously. Conse-quently,
the person who is attacked by
one may not become aware that any-thing
is seriously the matter for a long
time. A cancer of the skin, for example,
may continue for several years without
causing pain or other marked incon-venience.
Not only is a cancer small to begin
with, but it appears to be a distinctly
local disorder. Present day knowledge
gives no reason to suppose that it is a
constitutional or blood disease. On the
contrary, the weight of evidence is op-posed
to that supposition. No general
disease is in any respect like it. No
disease necessarily precedes it or is
related to it. It often attacks persons
who appear to be in perfect health.
In its early stages the cancer does
not affect the general health nor the
patient's spirits, and this is particularly
true if the patient does not know nor
suspect that he has cancel-. It is only
after the cancer has progressed con-siderably
that the general health is
impaired.
If, while the cancer is small, it is
completely removed by surgery or de-stroyed
with X-rays or radium, or, in
fact, by any other means, that is an end
of it. This could not be so if cancer
were a disease which affected the whole
body.
If, instead of being completely re-moved
or destroyed, the original cancer,
or any particle of it, is permitted to
live, additional cancers are apt to fol-low
either at the original site or else-where.
Thanks to the increasing knowl-edge,
the manner in which this happens
has become more and more apparent.
It has been proved that minute parti-cles
of the original cancer may be car-ried
to variovis parts of the body by the
lymph and blood and there establish
themselves as new cancers. The routes
by which these cancer cells are carried
are often known and in skillfully con-ducted
operations, the places where the
particles may have lodged are attended
to when the cancer itself is removed.
This information is of much value.
A good many deductions of practical
utility have been based on it. One is
that surgery or radiation must be ap-plied
before any migration of the little
particles has taken place, for after this
has occurred the removal of the original
cancer alone will not produce a perma-nent
cure. In early treatment lies the
hope of cure.
Gradually a more and more definite
meaning is being attached to the word
"cure" as applied to cancer. Physicians
are less willing today to say that a
patient has been cured of cancer than
they were formerly. Recurrences from
the growth of particles which have re-mained
dormant for a very long time
may occur. After five years, however,
the chance of recurrence is relatively
small. Consequently, physicians are
coming to measure the success of the
various methods of treatment which
they employ in terms of the number of
five-year cures which have been ef-fected.
Not Contagious or Inheritable
With the increasing knowledge, opin-ion
is becoming more and more securely
settled that cancer is not due to a para-site.
It would be a great step for-ward
if the public would learn to ac-cept
this opinion, for the possession of
it would dispel not a little of the fear
with which cancer is regarded. It would
also help to put an end to the promo-tion
of some "cures" which do not cure,
in other words, quackery, that greatest
of all cruelties, as so many writers
have declared.
If cancer is not due to a parasite,
it follows that the disease is not trans-missible
from person to person. This
18 The Health Bulletin January, 1926
is true of all diseases. It also follows
that a serum cannot be prepared which
will stop it.
It should be generally recognized
that cancer is not communicable, for
a belief that it is infectious has not
infrequently led to the shameful neg-lect
of patients who have had need of
the best care and attention which could
be given to the sick. Persons need have
no fear to live or work near one who
hr.s cancer.
As to the inheritability of cancer, the
general opinion among qualified stu-dents
of this question is that the dis-ease
itself is not inherited, but that
a certain lack of resistance toward it
may now and then exist in a family
for two or three generations. Experi-ments
which have been made in breed-ing
large numbers of mice have led
some i>ersons to get the wrong idea
that cancer or a predisposition toward
it might exist in some families in-definitely.
It is true that by carefully
selecting mates through hundreds of
generations, strains or families of mice
have been produced which are more
susceptible to certain forms of trans-planted
cancer than is commonly the
case, but nothing like such a predis-position
occurs among mice which are
left to mate as they will. The great
difficulty with which susceptibles can
be produced shows that the results ai'e
highly artificial. Apparently they have
no analogy among human beings under
the ordinary circumstances of every-day
life. For practical purposes, it is
reasonable to consider that cancer is
not transmissible from parent to off-spring
among human beings.
The Prevention of Cancer
Within the last few years it has been
found that the inciting cause of cancer
is in practically all instances some
form of chronic irritation. At the site
of the growth there has been for a
considerable time a mechanical, chemi-cal,
bacterial, or other irritating con-dition
which has in some way so dis-turbed
the natural resisting and re-pairing
function of the tissues that they
have at last given way and set out
upon a career of unrestrained and un-restrainable
growth. This theory has
now been so thoroughly investigated as
to be accepted universally as a funda-mental
and completely established fact.
To prevent cancer therefore is to pre-vent
the chronic irritations which lead
to it. One should beware of the broken
tooth or dental plate which continually
irritates the tongue, cheek or gums ; of
the spectacles which make the head
sore behind the ear, on the temples or
nose ; of any sore which will not heal
;
of the mole or wart that changes in
color, size or appearance; of indiges-tion
which will not stop and cannot be
explained ; or any unusual and un-natural
discharge from any part of the
body and of any lump which does not
go away.
When any of these conditions occur,
you should go at once to a capable
doctor and do what he advises. At
once means today. If the trouble is
not cancer, your discomfort will thus
be removed. If it is cancer, your
promptness may save your life. In deal-ing
with this disease, delay is not
merely dangerous : it is fatal.
When Johnny comes for his teeth to
be examined and we find his teeth are
poor and dirty, we teach him to brush
his teeth but we should also find out
why he has poor teeth. It is either one
of two things—either Johnny is poorly
nourished or Johnny's mother has been
poorly nourished before or after
Johnny was born, when she was un-able
to give him tooth-building food.
It is highly important to realize that
we have emotional habits as well as
habits of mind and body. We are
coming to realize the importance of
the psychology of the emotions in re-lation
to mental and bodily health. We
can definitely set for ourselves the goal
of forming habits of happiness, of en-joyment
and enthusiasm in our daily
life, of courage and of generosity
toward the opinions of others. Until
we realize that negative emotional
habits have just as much to do with ill
health as germs, we have fallen far
short of our standard.
—
Patty I. Hilx.
Man's happiness consists in the
means and not in the end ; in acquisi-tion
and not in possession.
January, 1926 The Health Bulletin 19
f
PUBLIC HEALTH NURSING*
20 The Health Bulleti>' January, 1926
be accomplished with systematic visita-tions
by a trained personnel to advise
them regai'ding general and personal
hygiene.
In order to try out his theories in a
practical way and to see whether the
suffering and misery of the sick could
not be alleviated by proper nursing and
home conditions improved by instruc-tions
in hygiene, he employed a nurse
who had been attending his wife, and
at his own expense, obtained her co-opei-
ation in making these visits.
The reports of these visits are most
interesting. We learn that the nurse
was instructed not only to give nursing
care to the sick, but to teach the fami-lies
how to take care of themselves and
of their own sick and how to lead the
proper kind of lives. So here again we
find social service work inevitably
bound up with visiting nursing, the
public-health nurse becoming the social
service worker as well.
The results of this feeble beginning
wex-e so satisfactory that, in 1859, with
the aid of Miss Nightingale, other
nurses were put on dutj' and of course
the work grew.
In reviewing an account of this work,
we have found a tendency and a right
one, to get away as far as possible
from actual medication and to empha-size
to the limit public-health hygiene
and prophylaxis, even though the
knowledge of the prevention of infec-tious
diseases in that day and time was
meager. We read that, in those times,
nurses were "urged over and over
again'' not to pauperize the patient by
giving medical comforts unless they
were actually necessary. Florence
Nightingale also saw this danger and
said : "If district nurses begin by giv-ing
relief they will end by doing noth-ing
but giving relief."
In modern public-health nursing of
today we are, in the same way, caution-ing
the public health nurse not to fall
into the error of practicing, to a great
extent at least, bedside treatment—to
remember that her duty is to preach
prevention and to leave the treatment
end of the disease to the practical
nurse or practitioner.
Public-health nursing in this country
was rather slow in developing. In 1828
Doctor Warrington, of Philadelphia, on-ly
23 years of age, inaugurated the so-ciety
of district nursing. At first it was
merely for the purpose of qualified
nursing attendance to poor women in
childbirth, but the work was gradually
extended to take care of all classes of
cases. The first charter of this organ-ization
read: (to) "Provide, sustain,
and cause to be instructed, as far as
iwssible. pious and prudent women as
nurses, it being understood that the as-sociation
does not confine itself to the
supply of monthly nurses only, but for
every variety of sickness of patients.'"
A district nursing organization was
started in Boston in 1886, and in 1888
the association was incorporated under
the name "Instructive District Nursing
Association," with the purpose not only
of caring for the sick but for giving
them instruction in home nursing and
public health. The objects of the asso-ciation
were stated to be
—
1. To provide and support thor-oughly
trained nurses who, acting
under the immediate direction of
the out-patient physicians of the
Boston Dispensary, shall care for
the sick poor in their own homes
instead of in hospitals.
2. By precept and example to
give such insti'uction to the fami-lies
which they are called upon to
visit as shall enable them hence-forth
to take better care of them-selves
and their neighbors by ob-serving
the rules of wholesome liv-ing
and by practicing the simple
arts of domestic nursing.
So, again, we see that the idea of
public-health instruction as a funda-mental
and most important duty of
public health nursing was all promi-nent.
This phase was being gradually
accepted by all as the most sensible
way of carrying on public health nurs-ing,
the nurse thinking more of the
community as a patient than of the
individual sick.
In 1893 Isabel Hampton, in an ad-dress
to the International Congress of
Nurses, said
:
In district nursing we are con-fronted
with conditions which re-quire
the highest order of work,
but the actual nursing of the pa-tient
is the least part of what her
work and influence should be
among the class which the nurse
January, 1926 The Health Bulletin 21
will meet with. To this brauch of
nursing: no more appropriate name
can be given than "Instructive
nursing,"' for educational, in the
best sense of the word, it should be.
The first special work in district
nursing was undertaken in London in
1892, when a staff of visiting nurses
was organized to visit the schools and
inspect school children. However, the
honor of inaugurating school nursing
in America is due to Miss Wald. found-er
of the Henry Street Settlement, who
in 1902 suggested the use of nurses to
supplement the work of doctors in the
schools of New York. Medical inspec-tion
of school children had been in
vogue in the schools before that time,
but it was merely a perfunctory exami-nation
by a physician, the only thing
accomplished being the exclusion of the
child, nothing being done to prevent
the cause of the illness, or a visitation
at the homes of the school children to
carry the principle and gospel of pre-vention
of disabling illnesses.
During these times of demonstrations
in public health nursing and the ai'ous-ing
of public interest in these demon-strations,
gradual progress was being
made in the requirements of those who
wi.shed to enter the nursing and medi-cal
professions. While nursing was
reaching the plane which it has now
attained as a profession, wonderful
strides were being made in the medical
profession toward the prevention of
diseases, such as the use of antitoxin
against diphtheria, inoculation to pre-vent
typhoid fever, and the valuable
work now being carried on toward the
standardization of antitoxin against
scarlet fever. The dangers of neglected
teeth, the tonsil and adenoid evil, and
the value of scientific baby care began
to be considered by the laity along with
their previous ideas of safeguarding the
health of cattle and hogs.
Dental prophylaxis, the outline of
programs for prenatal hygiene, and the
development of intensive school pro-grams
are all accomplishments which
demand highly trained nurses in the
public-health field for service in all
recognized full-time health departments.
In the early history of public-health
nursing we find that it had its incep-tion
in centers of population — the
cities. Those who lived in the country
and in rural districts were indeed
deemed fortunate. Living in the coun-try
(and the same idea has held to the
present day) was thought to be a pro-tection
against sickness. For this rea-son
public health of rural communities
has been, and still is, greatly neglected.
Thirteen years ago there was not one
full-time county health department in.
the United States among the three
thousand and odd counties composing
this country.
We finally awoke to the fact that a
real health problem existed in the coun-try,
and one of even greater importance
than the urban health question. The
death rate was higher, the morbidity
index was higher, and the rural dweller
did not have a protected water supply,
a protected milk supply, or proper
methods of sewage disposal, as pro-vided
by ordinances in cities. There-fore,
he drifted along by himself, con-tracting
typhoid fever from his own
water supply, polluted by his own sew-age,
and blaming the causation of the
disease on God. the devil, tin cans,
weeds, or whatever came to his mind.
It took us a long time to realize these
things, but since that realization full-time
county health units have been
organized and are in operation in over
280 counties in the country, with new
ones developing every year through the
financial cooperation of the Uniteector gives the
skipper not only his tax receipt, but
also a sanitary certificate. Before he
can sell his cargo to shuckers or cau-ners
he must produce this receipt and
certificate. Since all oyster boats leav-ing
North Carolina waters for other
markets must pass through the Dismal
Swamp canal, an insi)ector is stationed
at the locks in this canal and no cargo
of oysters can leave the state without
complying with the law.
Dredged in N. C. waters 301,095 bu.
Exported in the shell.... 30,245 bu.
Steamed within the
state, but exported to
to be sold under for-eign
label 211,047 bu.
Shucked within the
state and exported
fresh to be sold under
foreign label 58,303 bu.
Sold in shell within the
state 1,500 bu.
This brings us to the most lamentable
phase of the oyster situation.
Although North Carolina oysters are
the best and purest on the market, the
consumer has not been so advised.
The above figures furnished by the
Fisheries Commissioner for last season
show that practically the entire North
Carolina oyster crop was disposed of
8 The Health Bulletin February, 1926
incognito. Thirty thousand bushels
were taken in the shell outside the
state to be shucked and sold under a
foreign label. About 270,000 bushels
(one bushel or tub of best grade oysters
will shuck about one gallon) were
steamed or shucked within the state
but taken out of the state without label
to be marketed under a foreign label.
Many of these were shipi>ed back into
the state for consumption. The con-sumer
really ate North Carolina
oysters but thought he was getting an
out-of-the-state product.
With all this round about handling
there is not only much delay in reach-ing
the dealer, but the dealer pays an
average of $1.00 per gallon more for
North Carolina oysters which he buys
from a Norfolk or Baltimore shipper
than he would pay for the same oysters
bought from a North Carolina shipper.
The dealer can scarcely be blamed
for this for he must supply what his
customers call for—they are the ones
who pay the bill. The customer has
eaten "Norfolk" and "Baltimore"
oysters so long (without knowing that
in many instances they came from
North Carolina waters) that he thinks
he must have "Norfolk"' or "Baltimore"
oysters.
When consumers leaim the facts and
call for "North Carolina oy.sters" the
dealers will be glad to supply them.
The appended list shows the name,
address and permit number of 74 North
Carolina packers and shippers. Ship-ping
tins are now labeled "N. C. Permit
No "
When your dealer shows you a can
with this label stamped in the tin or
painted thereon you may be sure that
the oysters it contained when it left
the hands of the packer were safe for
food.
LIST OF OYSTER SHUCKERS AND PACKERS IN NORTH CAROLINA
Name Addrex
Permit
Number
Woodland & Company
Southgate Packing Co
Washington Fish Co
George N. Ives
G. W. Bowden.
Lupton Fish and Oyster Co
Reuben Williams -.
George Baker
George Moore
P. Speight .
E. S. Lupton ,/.
S. F. McCotter
Charles H. Squires _
J. W. Rollins...
S. E. Styron
Almon Hamilton
Wilbert Lewis
C. W. Greene ^-.
Ford Seafood Company _.
Manning Brothers
Amos H. Dudley
A. M. Boyd
U. S. Boyd
Swmdell-Fulford Co
Norfolk-Southern Meat Market
H. J. Shaw
A. Marbley
George Dudley .-
John Henry Becton
Elihu Boyd
Stephen Davis
Amos Dudley
Walter Bell
Pamlico Fish Company..
Morehead City.
Beaufort
Washington
New Bern
New Bern
New Bern
Belhaven
Belhaven
Washington
New Bern
New Bern
Vandemere
New Bern
Manteo
Davis
New Bern
Stacy
New Bern
Manteo
New Bern
Morehead City
Morehead City
Morehead City
Washington
New Bern
New Bern
Morehead City
Morehead City
Morehead City
Morehead City
Marshallberg...
Morehead City
Morehead City
Washington
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
N. C.
February, 1926 The Health Bulletin
LiIST OF OYSTER SHUCKERS AND PACKERS—Continued
Permit
Number
Eastern Fish Company
Henrietta Carter..
George R. Russell
Henry Bryant
James T. Salter
Willis Seafood Co
John Monroe
Jim Tillery
W. P.Boyd
Finer Brothers
Adams & Company
Tom T. Lassiter
C. H. Harris
Tolson-Sniith
Charles V. Webb
Duffy Wade
Haywood Bell
Mott Hester
Emma Dudley
A. W. Walston
Bert Tillery
Delia Jones
V. Taylor Packing Co.
.
Ernest Mattocks
W. H. Varnum
George Gorham
R. T. Alford
J. F. Morris & Son
Frank Ewing
T. J. Franks
C. L. Bowden
Lender Swindell
W. 1. Wilson
J. O. Bowden
Jim Pigott
X. M. Pigott
A. H. Parker
J. E. Hines
J. L. Phillips
E. .M. Chadwick
Washington
Morehead City
Beaufort, R. F. D
Morehead City
Davis
Beaufort
Morehead City
Morehead City
Morehead City
Morehead City
Morehead City
New Bern
New Bern
Morehead City
Morehead City
Morehead City
Morehead City
Morehead City
Morehead City
New Bern...
Morehead City
Morehead City
Sealevel
Morehead City
Supply
Washington
Seagate
New Bern
Wilmington..
Seagate
Wilmington
James City
Wilmington
Wilmington
Morehead City
Shallotte
Shallotte
Seagate _..
Washington
Gloucester
C. 35
C. 36
C. 37
C. 38
C. 39
C. 40
C. 41
C. 42
C. 43
C. 44
C. 45
C. 46
C. 47
C. 48
C. 49
C. 50
C. 51
C. 52
C. 53
C. 54
C. 55
C. 56
C. 57
C. 58
C. 59
C. 67
C. 68
C. 69
C. 70
C. 71
C. 72
C. 73
C. 74
FIVE THOUSAND DEATHS WITHOUT MEDICAL CARE
I
During the year 1924 there were in
North Carolina 5,515 persons who died
without medical care. That is, there
were this number whose death certifi-cate
show no doctor attended them. In
addition to this number tliere were
many more for whom the doctor was
called only at the last moment. In
this case he signed the certificate but
actually had not attended the patient
during the illness.
Many of these deaths could have been
prevented by the aid of a physician.
And this is the lamentable thing. What
does it avail for medical science to be
efficient in the curing of disease if
medical science has no opportunity to
exercise its skill?
We cannot believe it was physically
impossible for some physician to have
reached practically every one of these
imattended deaths. As a class, no pro-fession
is more liberal with its services,
therefore it is hardly probable that any
one of these unattended deaths could
not have gotten a physician had an ef-fort
been made to do so, however poor
the patient may have been.
Furthermore, society is generally
awake to the needs of its fellows and
10 The Health Bulletin February, 1926
provision is quite frequently made to
care for ttiose, at public expense, wlio
are themselves unable to bear the ex-pense.
The only actual reason then for
these unattended deaths is a matter of
ignorance—or carelessness. Ignorance
on the part of the family—or careless-ness
on the part of society.
Public sentiment througliout the state
should be aroused to the degree that
those responsible should be held in dis-gi'ace
if they allow any person in the
state to die without every effort being
made to secure adequate medical care.
Privilege brings responsibility and
every person who is granted the privi-lege
of wielding an influence in his
community is held morally responsible
for that influence. These are the per-sons—
these intelligent persons with in-fluence—
who are responsible for these
five or six thousand unattended deaths
each year in North Carolina. "Am I
my brother's keeper?" is a question that
must have an individual—a personal-answer.
But privilege is never given
except with commensurate responsi-bility.
An incident comes to mind, of which
the fact of every detail can be vouched
for, which illustrates an almost uni-versal
situation. The mother of nine
children was taken seriously and
mortally ill. The father was an honest,
hi.rd-working man whose every efCort
and every penny of earning was de-voted
to his family. They lived in a
rather densely populated and wealthy
county. The sick mother was taken to
a hospital where she remained until
it seemed impossible for the father to
raise more money to pay hospital bills.
The phjsicians attending her were the
best in the country but her malady
could not be cured and she was taken
home. One of the physicians who had
seen her in the hospital, along with the
other physicians, undertook to attend
her at home, although he knew he could
not in any possible way expect any
pay, and knew that her illness would
be prolonged. None of the surgeons
who had attended her in the hospital
had received any pay and did not ex-pect
any. This physician visited her
in the home 83 times. He took with
him in consultation, at different times,
six different physicians. He did, at the
house, three minor operations which
required the assistance of his ofiice
nurse. The minimum total foes this
doctor should have received for his
services to that home would have been
at least $300, yet he did the work as
willingly and as efiiciently without re-ceiving
one penny as if he had known
the money was forthcoming. This case
is no exception. Doctors are doing the
same thing everywhere.
In this case the responsibility was no
more on this doctor as a citizen of his
community than it was on every other
citizen. The doctor pays his city, coun-ty,
state and federal taxes, and is
charged by his state a special tax of
$25 per year for the "privilege"' of
practicing medicine. The burden is a
community burden and in this one case
this doctor paid, in services and ex-pense,
the equivalent of $300 tax, over
and above all the other taxes which the
butcher and baker and candlestick-maker
had to pay. And he paid a
special tax of $25 per year for the
privilege of doing it.
Today the doctor called ten miles in
the country to see a deserving, but
poor patient, will usually go, (doctors
are human and there are some who
would not go) but first he must drive
by the filling station to get gas for his
automobile. This he pays for in cash.
Then he remembers that his medicine
case needs filling, (for this is ten miles
in the country) so he drives by the
drug store, and some way even drug
supply houses have a habit of insist-ing
that drugs be paid for. Finally
after taking two or three dollars in
cash out of his pocket he goes to his
patient. He returns with a clear con-science
but wonders where he will get
the price of a beefsteak and a loaf of
bread to carry home for his supper.
There were very few of these five or
six thousand persons who died uilat-tended
in this state in one year who
could not have got medical aid in some
manner. There is no spot in the state
where you, who read this, could not
have very soon got medical aid had
your child, your wife or husband, or
your parent been sick unto death.
"Where there is a will there is a way"
and YOU would have found a way.
The responsibility is yours and mine
to see that unattended deaths do not
occur. As the matter now stands, the
charity of the medical profession.
February, 1926 The Health Bulletin 11
(freely offered to the needy individual,
but NOT to the well-to-do city, county
or state) may have to be accepted. As
soon as arrangements can be made, the
burden should be distributed to the
shoulders of those whose duty it is to
bear it. The county hospital is one
plan advocated by many, and is a plan
which deserves the most serious con-sideration.
The following table is appended
purely as a statement of facts. There
is no intent to make comparisons and
no need of further comment.
Table showing the total number of deaths during 1924 by race and by
counties. ALso showing the number of deaths